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.
Reasons for Obesity
Obesity Affects Quality of Life
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.
Obesity Classification Obesity has reached epidemic proportions in the U.S. over the past 20 years Classification BMI U.S. Pop Overweight >25.0 64% Obese (Class I) Obese (Class II) 30.0-34.9 35.0-39.9 21% Clinically Severe Obesity (Class III) >40.0 6%
Medical Treatment of Obesity
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
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
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
Who is Eligible for Bariatric Surgery? The NIH Consensus Panel Recommends That: Patients have a Body Mass Index >40 kg/m 2 100 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
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
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
Restrictive Surgery Sleeve Gastrectomy
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
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.
Resolution of Comorbidities N=104 1 year post-op Number Prior to Surgery % Worse % No Change % Improved % Resolved Osteoarthritis 64 2 10 47 41 Hypercholesterimia 62 0 4 33 63 GERD 58 0 4 24 72 Hypertension 57 0 12 18 70 Sleep Apnea 44 2 5 19 74 Hypertriglyceridemia 43 0 14 29 57 Peripheral Edema 31 0 4 55 41 Stress Incontinence 18 6 11 39 44 Asthma 18 6 12 69 13 Diabetes 18 0 0 18 82 Average 1.6% 7.8% 35.1% 55.7% 90.8% Improved or Resolved
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
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
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.
The Multidisciplinary Approach
Who is My Dedicated Team? Surgeon Registered Nurse Coordinator Registered Dietitian Psychologist/Social Worker Exercise Specialist Insurance Coordinator Administrative Assistant
What Medical Specialists are Involved? Gynecology Gastroenterology Anesthesiology Reconstructive Surgery Pulmonology Internal Medicine Cardiology Endocrinology Multidisciplinary Approach
Pathway to Bariatric Surgery
Support Groups
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
Nutrition after Weight Loss Surgery
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
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.
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
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
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
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
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
Start living your life today!
For more information contact: Karen Baumann, MSN, RN, Bariatric Coordinator (561) 737 7733, ext. 84688 KBaumann@BHinc.org