Catholic Medical Center & Androscoggin Valley Hospital. Surgical Weight Loss Options For a Healthier Tomorrow

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1 Catholic Medical Center & Androscoggin Valley Hospital Surgical Weight Loss Options For a Healthier Tomorrow

2 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

3 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 for individuals with one or more serious co-morbidities (diabetes, sleep apnea, heart disease)

4 Sizing Up Your Level of Body Fat Using the Body Mass Index (BMI)

5 Causes of Obesity Body weight is the result of: Genes Metabolism Culture Socioeconomic Status Behavior ***** Environment ***** Energy imbalance: More calories consumed than expended

6 Medical Complications of Obesity Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Gall bladder disease Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gout Idiopathic intracranial hypertension Stroke Cataracts Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis

7 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

8 Risks to Your Psychological and Social Well-Being Negative self-image Social isolation Discrimination Low self esteem Depression

9 Treating Obesity Diet and exercise Weight-loss programs Appetite suppressants Hypnosis, jaw-wiring, counseling

10 Qualifications for Weight Loss Surgery BMI > 40 or BMI 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

11 Weight Loss Surgeries at CMC Gastric Bypass Sleeve Gastrectomy Adjustable Gastric Banding

12

13 Benefits of Minimally Invasive/Robotic Assist Smaller incisions Less pain Quicker recovery Better wound healing Decreased risk of hernia

14 Minimally Invasive/Robotic Surgery 5-6 small incisions used to work within the abdomen

15 BYPASS BAND SLEEVE

16 Gastric Bypass

17 Sleeve Gastrectomy

18 Adjustable Gastric Banding

19 Excess Weight Loss 5 years BYPASS 60% SLEEVE 60% BAND 50% 10 years 70% TBD 60%

20 Procedure Comparison BYPASS SLEEVE BAND EWL RISK RE-OP DM RESOLUTION HIGH BP RESOLUTION SLEEP APNEA RESOLUTION COMPLICATIONS MORTALITY 0.1% 0.1% 0.01%

21 Procedure Comparison BYPASS SLEEVE BAND Hospital stay 2 days 2 days O days Return to work 2 weeks 2 weeks < 1 week

22 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

23 Effects of Bariatric Surgery

24 BYPASS BAND SLEEVE

25 Bariatric Surgery Reduces 5 YEAR MORTALITY RATES SURGERY NO SURGERY 0.68% 6.17%

26 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): July 30, 2009

27 Surgical Weight Loss Options Team Members Internal Medicine Physician Surgeons Dietitians Physician Assistants Nurse Practitioners Program Director Behavioral Health Specialists Exercise Physiologists

28 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

29 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

30 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

31 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

32 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

33 Questions??????

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