SUMMA HEALTH SYSTEM BARIATRIC CARE CENTER. Laura Ilg RD, LD Adrian Dan MD, FACS

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1 SUMMA HEALTH SYSTEM BARIATRIC CARE CENTER Laura Ilg RD, LD Adrian Dan MD, FACS

2 GOALS The Many Benefits of Bariatric surgery and Weight Reduction Bariatric Care Center Surgical Weight Loss Program Medical Weight Loss Program Behavioral Weight Loss Program The Role of the Dietitian in the BCC Discuss the 3 types of surgery we perform Laparoscopic Roux-en-y Gastric Bypass Laparoscopic Sleeve Gastrectomy Laparoscopic Adjustable Gastric Band

3 OBESITY IS A BIG PROBLEM A major health problem worldwide Affects 25% of the industrialized world American Statistics 65% of adults are overweight (BMI >25) 31% of adults are obese (BMI >30) 16% of adolescents are overweight 9% (15.6 million people) are morbidly obese (BMI >35) Medical expenditures of $117 billion in ,000 obesity related deaths annually National Institute of Diabetes and Digestive Disease (www.niddk.nih.gov)

4 WE CAN HELP! As medical professionals we can help to change all of this Weight loss and improvements in health can be accomplished in many non-surgical ways. Statistics show that diet and exercise only works for 1 in 20 (5%) of people who are morbidly obese Surgery is one of the best ways to obtain consistent, permanent weight loss for obese individuals The benefits of surgery outweigh the risks of staying morbidly obese

5 BARIATRIC SURGERY Bariatric is a Greek word Baros- (weight) -iatrike (medicine) Bariatrics is a field of medicine encompassing the study of being overweight, it s causes, prevention and treatment

6 MEDICAL CO-MORBIDITIES RELATED TO OBESITY Diabetes Hypertension Hyperlipidemia Cardiovascular issues Respiratory issues Sleep apnea Arthritis Depression Menstrual irregularity Stress incontinence

7 RESOLVED! Following bariatric surgery these medical conditions can be resolved Type 2 diabetes 95% Hypertension 92% Cardiac function 95% Sleep apnea 75% Osteoarthritis 82% GERD 98% Stress incontinence 87% Hyperlipidemia, depression and menstrual irregularity can all be improved greatly

8 OTHER BENEFITS There are other physical, economic and social comorbidities that can be resolved Many people take these things for granted Being able to wear the type of clothing you want Tying your shoelaces Crossing your legs Sitting comfortably in a restaurant, theater, bus, airplane, waiting areas, toilets, etc. Being hired/ promoted without discrimination Walking without difficulty Riding a bike Playing with children/ grandchildren HUGS!

9 SOCIAL BIASES Considered different People stare Lazy Dirty Unattractive Lack will power *Studies show that society has low respect for obese individuals. The same as they would for alcoholics and drug addicts. What these do all have in common is that they are all a DISEASE!

10 A DAILY INSPIRATION Obviously bariatric surgery and medical weight loss can help to prevent and cure disease and change lives It s a challenging and extremely rewarding field to work in Our patients become family It s an honor to be a part of their journey

11 SURGICAL WEIGHT LOSS PROGRAM Bariatric Care Center has been helping patients lose weight since 2004 Our Team: Bariatric Program Director 3 Surgeons Certified in Bariatric and General Surgery 1 General Physician certified in weight loss management 1 Certified Nurse Practitioner 2 RN Case Managers 1 Registered Dietitian 1 Exercise Physiologist 1 Psychologist Many office staff including: LPNs, MAs, MOAs, financial and billing specialists, etc.

12 WHO ARE OUR PATIENTS 2011 Demographics 238 NEW surgical patients 185 female patients (78%) 53 male patients (22%) Average age: 48 years old Average BMI: 48.4

13 WHO ARE OUR PATIENTS These patients are coming to us after years of yoyo dieting Some have struggled since they were very young children Weight has been affected by genetics, eating disorders, food addiction, emotional eating, poor habits, busy schedules, lack of nutrition knowledge, medications and disease to name a few. Some people feel surgery is the Easy way out or it s too extreme Not at all easy Life changing

14 GETTING STARTED Patients must meet certain medical criteria to be considered for surgery BMI of >35 with associated medical co-morbidities BMI of >40 Documentation of diet attempts considered ineffective Informational Group Seminar One-On-One Appointment with Surgeon Enroll in Program Physician monitored diet and exercise evaluations (depending upon insurance company) Nutrition assessment Psychological evaluation Cardiology, pulmonary, gastrointestinal and sleep evaluations, blood work-up

15 SCHEDULING SURGERY Once the patient is cleared and authorized by insurance we can SCHEDULE SURGERY! Many insurance companies cover bariatric surgery. There is a small fee to be a part of our program. After surgery is scheduled ALL patients must: Follow Optifast program Attend a 4 hour Pre-op Teaching Class Attend a 2 hour Exercise Class Meet with surgeon for final visit Complete pre-op testing After all of this is complete it is time for SURGERY!

16 SURGERY STATS 2011 Statistics Laparoscopic Roux en Y 198 Open Roux en Y 6 Laparoscopic Adjustable Gastric Band 11 Laparoscopic Sleeve Gastrectomy 25 Revisional Surgery Total Surgeries!

17 MORE TO COME REGARDING SURGERY

18 MEDICAL WEIGHT LOSS We offer a 14 week medical weight management program for those patient not interested in surgery This program includes at least 3 visits with our general physician specializing in weight loss management At least 2 visits with the dietitian 1 group exercise class and 1 one-on-one appointment with our exercise specialist Enrolled patients are given the tools and support needed to make healthy lifestyle changes. Patients are also recommended to meet with our psychologist as needed.

19 BEHAVIORAL WEIGHT LOSS MANAGEMENT PROGRAM Our Bariatric Psychologist will also see patients who struggle with emotional eating behaviors through the Behavioral Weight Loss Management Program. These patients can be referred from the Bariatric Care Center or from other doctor s offices These patients may or may not be interested in surgery

20 THE DIETITIAN S ROLE Surgical patients Bariatric Nutrition Assessment (BNA) Teach Optifast Class Teach nutrition part of pre-op class Visit to review diet in hospital upon discharge Post-op follow up visits 1 week, 1 month, 3 months, 6 months and 1 year for Roux en Y and Sleeve Gastrectomy patients Post-op follow up visits monthly for Laparoscopic Adjustable Band patients Medical patients See for initial nutrition assessment and 1 follow up visit Call patients 2 times during program to follow up on diet and exercise compliance

21 DIETITIAN S ROLE Review surgical and medical patient s lab results and contact them if they have any abnormal vitamin levels. It is very important for our patients to take the recommended vitamin supplements If they fail to do so, they WILL become deficient Proctor all of our monthly Bariatric Support Group meetings. Anyone is welcome to attend attendants per group We provide relevant topics and speakers Patients are welcome to share their personal stories Recommended to all patients

22 PLEASE WELCOME DR. ADRIAN DAN

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