Obesity Affects Quality of Life

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2 Obesity Obesity is a serious health epidemic. Obesity is a condition characterized by excessive body fat, genetic and environmental factors. Obesity increases the likelihood of certain diseases and other related health problems.

3 Reasons for Obesity

4 Obesity Affects Quality of Life

5 Obesity Increases Mortality Taken together, the diseases associated with morbid obesity markedly reduce the odds of attaining an average life span and raise annual mortality tenfold or more.

6 Obesity Classification Obesity has reached epidemic proportions in the U.S. over the past 20 years Classification BMI U.S. Pop Overweight > % Obese (Class I) Obese (Class II) % Clinically Severe Obesity (Class III) >40.0 6%

7 Medical Treatment of Obesity

8 Non-surgical Treatment Lifestyle Modifications low calorie diet, increase physical activity, adopt behavioral weight management techniques Dietary Modifications Limiting the amount of calories matters more than the source of the calories. Daily food log, requires significant planning, skills in estimating portion sizes and monitoring intake. Physical Activity Modifications Physical activity is integral role in weight maintenance. Behavior Modifications (BM) helps individuals develop a set of skills to achieve healthier weight. Pharmacotherapy Additional measure of consideration: Orlistat, Phentermine, Qsymia, Belviq

9 Why Surgery for the Treatment of the Clinically Severe Obese? Only surgery has proven effective over the long term for most patients with clinically severe obesity. NIH Consensus Conference Statement, 1991

10 Endorsements Surgery for the treatment of clinically severe obesity is endorsed by: The National Institutes of Health The American Medical Association The National Institute of Diabetes and Digestive and Kidney Diseases American Association of Family Practitioners

11 Who is Eligible for Bariatric Surgery? The NIH Consensus Panel Recommends That: Patients have a Body Mass Index >40 kg/m lbs. or more overweight Patients have a Body Mass Index between 35 and 40 kg/m 2 with significant co morbidities Patients have failed other medically managed weight loss programs 6% of the U.S. Adult Population (Over 12 Million People) Meet These Criteria

12 Ineligible Patients Exclusion Criteria: Obesity related to a metabolic or endocrine disorder History of substance abuse or untreated major psychiatric disease Surgery contraindicated or high risk Women who want to become pregnant within the next 18 months Inability to comprehend basic principles of bariatric surgery Unable to follow postoperative instructions

13 Bariatric Surgery Today Three Types of Most Commonly Performed Bariatric Surgery Procedures Restrictive Restrictive Combination Adjustable Abdominal Band Sleeve Gastrectomy Roux-en-Y Gastric Bypass

14 Restrictive Surgery Sleeve Gastrectomy

15 Laparoscopic Technique in Bariatric Surgery Laparoscopic technology yields: Less post op pain, early mobility (usually 2 4 hours after surgery). Wound complications are significantly reduced Hospital stay is brief usually 23 hours, except Medicare will stay 24 hours or more. Return to work in 1 week

16 Bariatric Surgery as a Tool Bariatric surgery will not work alone. Commitment to diet, exercise and support are intricate parts of your weight loss success.

17 Resolution of Comorbidities N=104 1 year post-op Number Prior to Surgery % Worse % No Change % Improved % Resolved Osteoarthritis Hypercholesterimia GERD Hypertension Sleep Apnea Hypertriglyceridemia Peripheral Edema Stress Incontinence Asthma Diabetes Average 1.6% 7.8% 35.1% 55.7% 90.8% Improved or Resolved

18 Possible Complications May Lead to Short or Long term Hospitalization and/or Re operation Infection, bleeding or leaking at suture/staple lines Blockage of the intestines or pouch Dehydration Blood clots in legs or lungs Vitamin and mineral deficiency Protein malnutrition Incisional hernia Death

19 Possible Side Effects Nausea and vomiting Gas and bloating Dumping syndrome Lactose intolerance Temporary hair thinning Depression and psychological distress Changes in bowel habits such as diarrhea, constipation, gas and/or foul smelling stool

20 Post-Operative Summary On Average, Gastric bypass Patients Will find that they have lost 65 80% of their excess body weight, the majority of it in the first 18 to 24 months after surgery. Also Sleeve Patients Will find that they have lost 66% of their excess body weight, the majority of it in the first 12 to 24 months. May have rapid improvements in the morbid side effects of their obesity, such as type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol levels.

21 The Multidisciplinary Approach

22 Who is My Dedicated Team? Surgeon Registered Nurse Coordinator Registered Dietitian Psychologist/Social Worker Exercise Specialist Insurance Coordinator Administrative Assistant

23 What Medical Specialists are Involved? Gynecology Gastroenterology Anesthesiology Reconstructive Surgery Pulmonology Internal Medicine Cardiology Endocrinology Multidisciplinary Approach

24 Pathway to Bariatric Surgery

25 Support Groups

26 Support Groups The Heart of the Program Create fellowship through a common bond Provide a source of up to date information about surgery and latest developments Educate in nutrition, exercise, and post op needs Promote networking Increase bariatric surgery success Support life style changes

27 Nutrition after Weight Loss Surgery

28 Pre-operative Diet Goals Begin Creating Healthy Nutritional Patterns: Multivitamin and mineral intake Adequate fluid intake Quality versus quantity Pre op diet prior to surgery for safety Avoiding the last supper syndrome

29 Diet Progression A low sugar, clear liquid diet, started in the hospital after surgery. It essentially provides hydration during the initial post operative phase. A full liquid diet providing all the essential requirements for the first four weeks. A soft diet is introduced when the RN/Surgeon instructs the patient when to advance to this diet. Introducing semi solid food or solid diet too early may lead to obstruction and vomiting.

30 Fluids Recommended fluid intake: min. 64oz. a day Non carbonated Non calorie Not during meals Continually sip water throughout the day to ensure adequate hydration Avoid caffeinated beverages

31 Long-term Diet Goals Avoid concentrated sweets due to high calorie content and the possibility of dumping. Low fat, heart healthy diet. Maintain adequate water intake. Daily Vitamins and Minerals

32 Your Role Before Surgery Commit to improving your health (diet, exercise, mental readiness) Stop Smoking (Insurance companies are not approving if you are a smoker) Ask questions and vocalize concerns that you may have about surgery or your care. Commit to following all instructions on nutrition, activity and other care after surgery. Start Support Groups provided by the Program. Pre surgical 2 week liquid diet prior to surgery

33 Your Commitment Adhere to diet Exercise daily Commit to lifelong follow up with the program. Attend support group meetings before surgery and participate regularly after surgery. Take vitamin and mineral supplements for the rest of your life Avoid tobacco products lifelong and alcohol for at least 1 year post op

34 Our commitment to you We will give you a plan We will be responsive to your needs before and after surgery We will be your partner in healthcare, we are Bethesda Health

35 Start living your life today!

36 For more information contact: Karen Baumann, MSN, RN, Bariatric Coordinator (561) , ext