Weight Loss Surgery Educational Seminar

Weight Loss Surgery Educational Seminar Attendee Handout Obesity Overview Obesity is on the rise in the US Body Mass Index (BMI) (see chart in this handout, page 9) o 18.5-24.9: Ideal Less than 1/3 of US adults o 25-29.9: Overweight 1/3 of US adults o 30: Obesity 1/3 of US adults 30-34.9: Obesity Category I 35-39.9: Obesity Category II 40: Morbid Obesity 5 of 100 people Obesity Increases Risk of Death Obesity Affects Every Organ System Obesity causes or aggravates these conditions. Losing excess weight and keeping it off frequently results in eliminating, decreasing, or preventing these conditions. Neurological o Carpal Tunnel Syndrome o Pseudotumor cerebri (increase in pressure in the fluid surrounding the brain and spinal cord) Cardiovascular: o Hypertension (high blood pressure) o Heart attack o Stroke o Hardening of arteries (Atherosclerosis) o Varicose veins o Blood clots: Deep Venous Thrombosis (blood clot in deep vein) Pulmonary Embolism (blood clot travels to lung) Dermatological o Rashes o Chronic skin irritation Gastrointestinal o Gallstones o GERD (acid reflux/chronic heartburn) o Fatty liver, including nonalcoholic steatohepatitis (NASH) (fatty liver with inflammation and scarring) o Cirrhosis (normal liver cells replaced by scar tissue) Southwest Bariatric Surgeons, PLLC Page 1 of 10

Musculoskeletal o Arthritis backs, hips, knees, ankles o Disc disease o Back strain Psychological o Depression o Eating disorders Metabolic o Diabetes o High cholesterol o High triglycerides Respiratory o Asthma o Obstructive sleep apnea (airway obstruction during sleep) Reproductive/Genital o Polycystic ovarian syndrome (characterized by irregular/no periods, other symptoms) o Increased risk of pregnancy/fetal abnormalities o Low testosterone o Urinary stress incontinence Increased cancer risk Uterus Breast Ovary Prostate Pancreas Liver Health Care Costs Studies published in 2004 show weight loss surgery makes economic sense. o Obese people under 65-years-old have 36% higher expenditure for medicine than non-obese people. o 77% reduction in Type II diabetes and hypertension medicines after weight loss surgery o Roux-en-Y gastric bypass is more cost-effective than medical management in reducing and maintaining weight loss at five-year followup. o Number of prescription drugs taken usually decreases dramatically after weight loss surgery. Southwest Bariatric Surgeons, PLLC Page 2 of 10

Successful Treatment of Obesity Can Reduce risk of dying Minimize obesity-related health problems Reduce health care expenditures Improve overall quality of life Diet and exercise work. Unfortunately, only 2-5% of people with severe obesity keep weight off at 5 years. In contrast, most weight loss surgery patients keep weight off at 5 years. #1 Reason our patients tell us they have surgery: To be there for children and grandchildren Gastric Bypass (Roux-en-Y) Most popular bariatric procedure in the U.S. Overview o Restrictive procedure with a malabsorptive component o Stapling/division of stomach to form a small pouch connected to the small bowel o Remaining stomach left inside. Continues to produce gastric juices. (Intestine leading from it gets connected farther down the tract.) o Excess weight loss shown: 60-80% within two years Why Does it Work? o Stomach pouch = eat less o Aversion to sweets due to dumping syndrome o Bypass element of procedure results in not absorbing all that is eaten Decreased glucose absorption Roux-en-Y Gastric Bypass Decreased fat absorption o Decreased gastric hormone and gastric juice production Side Effects o Micronutrient deficiencies, including B12, folate, thiamine, calcium, and iron o Dumping syndrome (70-75% of patients) Gastric Bypass Performed Using Laparoscopic Method o First-choice gastric bypass method (Southwest Bariatric Surgeons) 6 small incisions that are ½ inch to1 inch, each o 2-night hospital stay o Quicker recovery than in open procedure o Reduces risk of some complications Risks and Complications o Complications Wound Infections Incisional Hernias Anastomotic Stenosis (narrowing at connection) Southwest Bariatric Surgeons, PLLC Page 3 of 10

o Operative Mortality (Death) Pulmonary Embolism Respiratory Failure Heart Attack Postoperative Leakage and Sepsis o Mortality rates are lower than other common operations, including heart bypass (CABG) and aortic aneurysm Laparoscopic Adjustable Gastric Banding (Lap-Band and Realize Band) Overview o Silicone band placed around the top of the stomach o Tubing connected to an access port located under the skin (not visible) o Adjustments performed in the office o Laparoscopic 5 small incisions 1/2 inch to 1 inch, each o Restrictive no malabsorptive component o Completely reversible anatomy remains intact o Adjustable depending on weight loss needs Weight Loss o Gradual over a 2-year period o Lost weight has been shown to stabilize at 50-70% of excess weight History o In use since early 1990s o Lap-Band FDA-approved in 2001, Realize Band in 2007 (BMI 40 or 35 with comorbidity) Why Does the Adjustable Gastric Band Work? o Stomach pouch = eat less food and get full faster o Slowed emptying of the pouch via the outlet = feel full longer o Addition/removal of saline via the port adjusts band tightness Risks and Complications o Gastric prolapse and concentric dilatation (aka slip ) o Gastric erosion o Obstruction o Port site hernia o Port site infection o Tubing leaks Lap-Band o Death. Chief causes: Pulmonary embolism, respiratory failure, heart attack Mortality rates are lower than other common operations, including heart bypass (CABG) and aortic aneurysm Online Tools: Lap-Band and Realize Band Websites o Patients gain access to online tools designed to foster success with their band. Tools include goal-setting and tracking, meal-planning, fitness help. Southwest Bariatric Surgeons, PLLC Page 4 of 10

Sleeve Gastrectomy (aka Gastric Sleeve and Vertical Gastrectomy) Overview o Stomach is shaped into a sleeve. Excess stomach is removed. o Purely restrictive, no malabsorptive component o Early studies show decreased complications in high-risk groups when bypass not advisable o Can perform as 1st stage if 2-stage procedure required. Second stage can be bypass or duodenal switch o Rarely covered by insurance Weight Loss o More gradual than with gastric bypass, but faster than with adjustable gastric band o Excess weight loss: 50-70% within two years Why Does It Work? o It helps you be satisfied with less food o Small stomach = get full faster Stomach now a tube that holds approximately 1/2 cup of food o Slowed emptying of the pouch helps you feel full longer Complications o Reflux o Bleeding o Stricture (narrowing) o Operative Mortality (Death) similar to other bariatric procedures: Pulmonary Embolism Respiratory Failure Heart Attack Postoperative Leakage and Sepsis Weight Loss Surgery Summary Success requires lifelong commitment to change o Procedures are tools Surgery can be defeated with high-calorie liquids Periodic follow-up with your surgeon is vital for success Who is a Candidate for Weight Loss Surgery? BMI 40 or BMI 35 with at least one obesity-related co-morbidity (type and severity of co-morbidity are factors) Documented attempts at weight loss If you are age 60 or older, your age will be considered along with your BMI and health in determining whether you are a candidate for surgery. Your insurance policy may have additional requirements you ll need to meet. We strongly recommend that you call your insurance company to learn about your requirements. If you provide us with your insurance information, we will contact your insurance company for information about your requirements. Southwest Bariatric Surgeons, PLLC Page 5 of 10

Procedure Summary and Comparison Gastric Bypass Sleeve Gastrectomy Adj. Gastric Band Procedure Type Restrictive Restrictive Restrictive and Malabsorptive Laparoscopic Preferred (99%) Yes Yes Hospital stay 2 nights (avg) 1 night (avg) Same day or 1 night Adjustable No No Yes Reversible No No Yes Return to Work 2 weeks (avg) 1-2 weeks (avg) 1 week (avg) Supplements Vitamins, B-12, Vitamins, Vitamins folic acid, others B-12 sublingual Weight Loss Initially rapid More gradual Most gradual Weight Loss Surgery Nutrition Patients meet with our dietitian prior to surgery. Our dietitian is also available after surgery for questions and additional consultation. You ll follow a pre-op diet before surgery. The goal is to shrink your liver and make surgery safer. You ll eat regular foods on this diet. Eating Methods after Surgery and Vitamin Supplements see page 8 Dumping Syndrome see page 8 Southwest Bariatric Surgeons Surgery in Austin and Round Rock o 2 surgeons in the operating room Ongoing care in Austin or Round Rock by your surgeon. Your surgeon will provide your care personally, not have you see assistants instead. There is always an experienced bariatric surgeon available to care for our patients even at night and on weekends and holidays. Licensed Dietitian on staff for pre-op and post-op consultations and questions Patient Advocates to help with insurance approval Weight Loss Surgery Program Pre and post-op consultations with your surgeon (personally) Licensed dietitian on staff pre-op consultation, post-op support Pre-op testing/consultation (hospital) o medical tests o psychologist consultation o exercise physiologist Support groups (hospital) Southwest Bariatric Surgeons, PLLC Page 6 of 10

Austin Clinic 3705 Medical Parkway, Suite 210 Austin, TX 78705 512.338.5024 New Patient Line: (Located near Seton Medical Center Austin. Building is just south of 38 th Street, 1 block west of Lamar.) Round Rock Clinic 301 Seton Pkwy, Suite 102 Round Rock, TX 78665 512.498.4860 New Patient Line: (Located in the Medical Office Building behind Seton Medical Center Williamson.) Southwest Bariatric Surgeons, PLLC Page 7 of 10

Nutritional Considerations for Weight Loss Surgery Patients Eat Slowly- Aim for 30 chews per bite of food. Bite size should be equal to the size of a small grape. Stop eating as soon as you feel full. Eat only 3 balanced meals per day with no snacks. No liquid intake 30 minutes before meals, with meals, or one hour after meals. Avoid soups and cold cereals which have a liquid composition. Aim for 8 glasses of water per day. All fluid intake needs to be between meals. No liquids with calories. Take multivitamin daily. Vitamin must be crushed, chewable, or liquid. o Adjustable gastric band - Adult multivitamin with iron once daily or children s chewable vitamin twice daily. o Gastric Bypass- Adult multivitamin with iron twice daily or children s chewable vitamin two or three times daily. Will need additional supplementation including calcium, B-12, and possibly thiamine and iron. Dumping Syndrome- Only occurs with gastric bypass. o 70-75% of gastric bypass patients o Triggered by high fat or high sugar foods o Symptoms can be immediate and last from 1 to 4 hours after a meal o Symptoms: cramping, diarrhea, sweating, fatigue, weakness, hypoglycemia, and hunger Pre-op Diet Prior to surgery, you will need to be on a diet designed to shrink your liver. You ll be given this diet at your nutrition consult. You ll start it two weeks prior to your surgery date (unless your surgeon instructs you otherwise). Diet Progression After Surgery o Liquids o Pureed o Soft Solids o Regular Adjustable Gastric Band: Patients are typically back on regular foods in 4-6 weeks Sleeve Gastrectomy: Patients are typically back on regular foods in 4-6 weeks Gastric Bypass: Patients are typically back on regular foods in 6-8 weeks Southwest Bariatric Surgeons, PLLC Page 8 of 10

Southwest Bariatric Surgeons, PLLC Page 9 of 10

Patient Process Attend seminar. Send in preliminary history questionnaire, Privacy receipt, and front-and-back copy of insurance card. You ll receive a call regarding insurance benefits and scheduling an appointment with the surgeon. Have initial consult with surgeon. Surgeon determines whether patient is a candidate for surgery. (Bring blue folder with all forms completed.) Using Insurance Not Using Insurance (Cash-Pay) Southwest Bariatric Surgeons submits info to your insurance carrier for pre-determination of whether insurance will cover surgery. Receive notification of approval, request for more info from insurance company, or denial. Undergo pre-operative testing. Have pre-operative visit with your surgeon. Schedule surgery. Approval Undergo pre-operative testing. Request for more info Denial Start pre-op diet. Stay on 2 weeks up to surgery (longer if recommended). Have pre-operative visit with your surgeon. Schedule surgery. NOTE: The date will come from our office. Please ignore any date your insurance company gives you. Provide additional info. Undergo any required consults or testing. Appeal according to your insurance company s process OR proceed as cashpay. Have surgery. Southwest Bariatric Surgeons expects payment for surgery from patients at least 7 days prior to the procedure. Start pre-op diet. Stay on 2 weeks up to surgery (longer if recommended). Have surgery. Approval Denial NOTE: This chart shows only the process up to surgery. Post-operative care is important for your health and weight loss success. Southwest Bariatric Surgeons, PLLC Page 10 of 10