Download Surgical Treatments for Obesity

Is bariatric
surgery
the answer
for you?
033593-150423
Is bariatric
surgery
the answer
for you?
Surgeon Name(s)
Title
Practice Name
Enter date
033593-150423
Our practice
Key personnel
•
•
•
•
•
•
Surgeon
Bariatric Coordinator
Nurse Practitioner
Physician Assistant
Dietitian
Insurance Coordinator
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What brings us here?
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are you going to learn today?
•
•
•
•
•
•
What is obesity?
Your daily challenges
What is obesity costing you?
What are your surgical options?
Summary
What are your next steps?
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What is
obesity?
Obesity is…
…a disease in which fat has accumulated to the
extent that health is impaired.
It is also…
• multi-factorial (many different factors can cause obesity)
• life-long
• progressive
• potentially life-threatening
• costly
September 26, 2008
American Obesity Association. Fact Sheet: Obesity in the U.S. May 2, 2005. http://www.obesity.org
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Obesity is a complex, multi-factorial, chronic
metabolic disease
Obesity involves the following factors:
Genetic
Metabolic
Environmental
Physiological
Behavioral
Psychological
September 26, 2008
American Obesity Association. Fact Sheet: Obesity in the U.S. May 2, 2005. http://www.obesity.org
A contributing factor to obesity is the
body’s metabolic “set point”
September 26, 2008
Sumithran P, Prendergast, LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011; 365:1597-1604
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many serious health conditions
are related to obesity
Depression
Pulmonary disease
abnormal PFTs
obstructive sleep apnea
hypoventilation syndrome
Stroke
GERD
Cardio/Metabolic Syndrome
Nonalcoholic fatty liver
disease
diabetes
dyslipidemia
hypertension
metabolic syndrome
steatosis
steatohepatitis
cirrhosis
Gallbladder disease
Severe pancreatitis
Gynecologic abnormalities
Cancer
abnormal menses
infertility
polycystic ovarian syndrome
stress incontinence
breast, uterus, cervix, colon,
esophagus, pancreas
kidney, prostate
Osteoarthritis
References at end of presentation.
Skin
Gout
Phlebitis
September 26, 2008
venous stasis
Premature Death
How do we measure obesity?
According to the National Institute of Health –
Body Mass Index (BMI) is a measure of body fat based on
height and weight that applies to both adult men and women
Classification
BMI Indicators
Normal
BMI
Health Risk
18.5-24.9
Overweight
25.0-29.9
Mild
Obesity (class I)
30.0-34.9
Moderate
Obesity (class II)
35.0-39.9
Severe
40+
Very Severe
Extreme Obesity (class III)
September 26, 2008
NHLBI. Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. October 2000.
http://www,nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
You’re not alone
•
Approximately 70% of adults are overweight or obese.1
•
17% of children (2-19 years old) are obese.2
•
6.3% of adults are extremely obese (BMI ≥ 40).1
•
Total medical costs for obesity in 2008 was $147 billion.3
•
112,000 obesity-related deaths occur annually.4
1.
2.
3.
4.
National Center for Health Statistics. Health, United States, 2011: With special feature on socioeconomic status and health. 2012.
Ogden C, Carroll MD. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010; 303(3): 242-249.
September
26, attributable
2008
Finkelstein, EA, Trogdon, JG, Cohen, JW, and Dietz W. Annual medical
spending
to obesity: Payer- and service-specific estimates. Health Affairs 2009;
28(5): w822-w831.
Flegal KM, Graubard BI, Williams DF et al. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293(15):1861-1867.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many people face the same issues
Percent Obese (BMI ≥30)
September 26, 2008
Centers for Disease Control. Adult Obesity Prevalence Maps. Downloaded Nov 20, 2012 from http://www.cdc.gov/obesity/downloads/DNPAO-State-Obesity-Prevalence-Map-2011.pptx
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many people face the same issues
Percent Obese (BMI ≥30)
September 26, 2008
Centers for Disease Control. Adult Obesity Prevalence Maps. Downloaded Nov 20, 2012 from http://www.cdc.gov/obesity/downloads/DNPAO-State-Obesity-Prevalence-Map-2011.pptx
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many people face the same issues
Percent Obese (BMI ≥30)
September 26, 2008
Centers for Disease Control. Adult Obesity Prevalence Maps. Downloaded Nov 20, 2012 from http://www.cdc.gov/obesity/downloads/DNPAO-State-Obesity-Prevalence-Map-2011.pptx
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many people face the same issues
Percent Obese (BMI ≥30)
September 26, 2008
Centers for Disease Control. Adult Obesity Prevalence Maps. Downloaded Nov 20, 2012 from http://www.cdc.gov/obesity/downloads/DNPAO-State-Obesity-Prevalence-Map-2011.pptx
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Many people face the same issues
2013*
Percent Obese (BMI ≥30)
September 26, 2008
Centers for Disease Control. Adult Obesity Prevalence Maps. Downloaded Nov Apr. 23, 2015 from http://www.cdc.gov/obesity/data/table-adults.html
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
*Survey methodology
changed to include
cell phone interviews
in 2011, thus results
cannot be directly
compared to prior
years.
Your daily
challenges
You face obstacles and prejudices every day
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
High BMI can decrease life expectancy
Relative risk of mortality reduced by 89% in a five year period
9
8
Years of Life Lost
7
6
5
Age 20
Age 30
4
Age 40
Age 50
3
2
1
0
28
29
30
31
32
33
34
35
36
37
38
Body Mass Index
39
40
41
42
43
44
Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care
September 26, 2008
Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
Fontaine KR, Redden DT, Wang C et al. Years of life lost due to obesity. JAMA 2003; 289:187.
Graph represents years of life lost for white women.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
≥45
What is obesity
costing you?
What are the costs for you?
Conventional treatments
Commercial diet programs
Weight loss supplements
Pharmaceuticals
Day-to-day living
Clothing
Food
Medical expenses
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
% Increase in Utilization
Medical visits and costs go up as BMI
goes up
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
BMI 30 - 34.9
(Class I Obesity)
BMI > 35
(Class II & III
Obesity)
September 26, 2008
Utilization rates as a proportion compared to normal or underweight persons (BMI<25).
Quesenberry CP, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch
Intern Med 1998;158(5):466-472.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Cost of not treating obesity
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are your
surgical options?
Are you a candidate for bariatric surgery?
•
•
•
•
•
•
•
BMI >35 with co-morbidities (obesity related diseases) or >40
without*
Healthy enough to undergo a major operation
Failed attempts at medical weight loss
Absence of drug and alcohol problems
No uncontrolled psychological conditions
Consensus by multi-disciplinary team
Understands surgery and risks
Must be dedicated to a lifestyle change
and lifetime follow-ups
September 26, 2008
National Institutes of Health. The practical guide: Identification, evaluation, and treatment of overweight and obesity in adults. NIH Publication Number 00-4084; 2000.
Only a patient and their physician can determine if surgery is right for them. All treatment options should be discussed with health care professionals.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Several surgical approaches are available
1.
Roux-en-Y Gastric Bypass
2.
Vertical Sleeve Gastrectomy
3.
Adjustable Gastric Band
4.
Biliopancreatic Diversion with Duodenal Switch
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Roux-en-Y gastric bypass
•
Laparoscopic
Roux-en-Y Gastric Bypass
•
Mean excess weight loss at 3 years
of 62%1
•
No implanted medical device
•
Low rate of complications2
•
Changes the signals your stomach
sends to the rest of your body,
including your brain, that control your
blood sugar levels, feelings of
fullness, and hunger.
1. O’Brien PE, McPhall T, Chaston TB, et al. Systematic review of medium-term
loss after bariatric operations. Obes Surg. 2006; 16(8): 1032-1040.
Septemberweight
26, 2008
2. Buchwald H. 2004 ASBS Consensus Conference Statement, Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and
third party payers. SOARD 2005;(1):371-8.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Roux-en-Y gastric bypass
•
The surgeon creates a small pouch,
reducing the amount of food a patient
can eat.
•
The stomach pouch is then surgically
attached to the middle of the small
intestine, skipping the rest of the
stomach and the upper portion of the
small intestine (duodenum).
•
Bypassing part of the intestine may
limit the amount of calories that are
absorbed and send messages to your
brain to help you feel full. September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Roux-en-Y Gastric Bypass
How is the Roux-en-Y gastric bypass done?
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are the risks and complications of
the Roux-en-Y procedure?
•
•
•
•
•
•
•
Dehiscence (separation of tissue that was stitched or stapled together)
Leaks from staple lines
Ulcers
Dumping syndrome, an unpleasant side effect that may include vomiting,
nausea, weakness, sweating, faintness, and diarrhea
Required supplementation of diet with a daily multivitamin, calcium, and
sometimes vitamin B12 and/or iron
Inability to detect the stomach, duodenum, and parts of the small
intestine using X-ray or endoscopy, should problems arise after surgery
such as ulcers, bleeding, or malignancy
Increased gas
September 26, 2008
Note: Your weight, age and medical history play a significant role in determining your specific risks.
Your surgeon can inform you about your specific risks for bariatric surgery.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What can you expect after the
Roux-en-Y procedure?
Recovery takes time and patience
• The diet is strict.
• You may experience discomfort and pain as your body heals.
• Length of time to return to normal activities can vary from patient to patient.
• Some patients are able to return to work within a few weeks and see
weight loss fairly soon after surgery. For others, a couple of months go by
before they experience noticeable weight loss.
One study found that the median time laparoscopic
gastric bypass patients1:
• Started on oral diet in 1.58 days
• Left the hospital on the second day
• Returned to work at 21 days
September 26, 2008
Schauer P, Ikramuddin S, Gourash W, et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000 Oct;232(4):515-29.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Vertical sleeve gastrectomy
Vertical Sleeve Gastrectomy
•
Laparoscopic
•
Mean excess weight loss at 3
years of 66%1
•
No implanted medical device
•
Changes the signals your
stomach sends to the rest of your
body, including your brain, that
control your blood sugar levels,
feelings of fullness, and hunger.
September 26, 2008
1. Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012 May; 22(5): 721-31.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Vertical sleeve gastrectomy
Vertical Sleeve Gastrectomy
•
Surgeons create a small stomach
“sleeve,” or pocket, that is shaped
like a banana.
•
After the “sleeve” is created, the
leftover part of the stomach is
removed.
•
When you eat, the food goes from
the sleeve to the intestine, where
it is absorbed.
September 26, 2008
1. Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012 May; 22(5): 721-31.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
How is vertical sleeve gastrectomy
performed?
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are the risks and complications
of a vertical sleeve gastrectomy?
•
•
•
•
•
•
•
Abdominal hernia
Chest pain
Collapsed lung
Constipation or diarrhea
Dehydration
Enlarged heart
Gallstones, pain from passing a
gallstone, inflammation of the
gallbladder, or surgery to remove
the gallbladder
•
•
•
•
•
Gastrointestinal inflammation
or swelling
Stoma obstruction
Stretching of the stomach
Surgical procedure repeated
Vomiting and nausea
September 26, 2008
Note: Your weight, age and medical history play a significant role in determining your specific risks.
Your surgeon can inform you about your specific risks for bariatric surgery.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What can you expect after
vertical sleeve gastrectomy?
Recovery will time will take time and patience.
• The diet is strict.
• You may experience discomfort and pain as your body heals.
• Length of time to return to normal activities can vary from patient to patient.
• The capacity of the stomach has changed.
• Your healthcare team will advise you when to return to work,
resume prior activities and schedule your follow-up appointments.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Biliopancreatic diversion with
duodenal switch
Biliopancreatic Diversion
with Duodenal Switch
•
Laparoscopic
•
Mean excess weight loss at 3
years of 75%1
•
No implanted medical device
•
Changes the signals your
stomach sends to the rest of your
body, including your brain, that
control your blood sugar levels,
feelings of fullness, and hunger.
September 26, 2008
1. Baltasar A, Bou R, Bengochea M, et al. Duodenal switch: an effective therapy for morbid obesity—intermediate results. Obes Surg. 2001;11:54– 58.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Biliopancreatic diversion with
duodenal switch
•
Surgeons create a small stomach pouch
shaped like a tube, making the overall
stomach size smaller, so it holds less
food.
•
The small intestine is then divided into 2
parts. The lower part is then attached to
the new, smaller stomach.
•
These changes to the digestive tract:
• cause food to pass by most of the
small intestine and not mix with
digestive enzymes until very far down
the tract.
• reduce the amount of food you eat and
September 26, 2008
make better use of the food you do eat.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Biliopancreatic Diversion
with Duodenal Switch
How is biliopancreatic diversion with
duodenal switch performed?
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are the risks and complications of a
biliopancreatic diversion with duodenal switch?
•
•
•
•
•
•
•
Dehiscence (separation of tissue that was stitched or stapled together)
Leaks from staple lines
Ulcers
Dumping syndrome, an unpleasant side effect that may include vomiting,
nausea, weakness, sweating, faintness, and diarrhea
Required supplementation of diet with a daily multivitamin, calcium, and
sometimes vitamin B12 and/or iron
Inability to detect the stomach, duodenum, and parts of the small
intestine using X-ray or endoscopy, should problems arise after surgery
such as ulcers, bleeding, or malignancy
Increased gas
September 26, 2008
Note: Your weight, age and medical history play a significant role in determining your specific risks.
Your surgeon can inform you about your specific risks for bariatric surgery.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What can you expect after biliopancreatic
diversion with duodenal switch?
Recovery will time will take time and patience.
• The diet is strict.
• You may experience discomfort and pain as your body heals.
• Length of time to return to normal activities can vary from patient to patient.
• The capacity of the stomach has changed.
• Your healthcare team will advise you when to return to work,
resume prior activities and schedule your follow-up appointments.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Adjustable gastric banding
•
Laparoscopic
•
Mean excess weight loss at 3 years
of 41%1
•
Requires implanted medical device
Adjustable Gastric Banding
•A
small pouch is created, which limits the
amount of food patients can eat.
• The
smaller stomach pouch fills quickly,
helping patients feel satisfied with less
food.
September 26, 2008
1. Philips E, Ponce J, Cunneen SA, et al. Safety and effectiveness of REALIZE adjustable gastric band: 3-year prospective study in the United States. Surg
Obes Rel Dis. 2009; 5: 588-597, p<0.001
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Two gastric bands are currently available
to your doctor
Ethicon Endo-Surgery Curved Adjustable Gastric Band®
(ETHICON, Johnson & Johnson)
• Insurance verification resources
• Financing resources for self-pay patients
• First to market globally
LAP-BAND® (Allergan)
• First to market US
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
How is adjustable gastric banding done?
For practice to insert own video
or an ETHICON procedure
video separately approved for
patient-facing use
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What are risks and
complications of gastric banding?
•
•
•
•
•
•
•
Migration of implant (band erosion, band slippage, port displacement)
Tubing-related complications (port disconnection, tubing kinking)
Band leak
Port-site infection
Esophageal spasm
Gastroesophageal reflux disease (GERD)
Inflammation of the esophagus or stomach
September 26, 2008
Note: Your weight, age and medical history play a significant role in determining your specific risks.
Your surgeon can inform you about your specific risks for bariatric surgery.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What can you expect after
gastric banding?
Recovery takes time and patience.
• The diet is strict.
• The capacity of the food you can eat has changed.
• You may experience discomfort and pain as your body heals.
• Length of time to return to normal activities can vary from patient to
patient.
• Your healthcare team will advise you when to return to work and
resume prior activities.
• Lifestyle changes are necessary to ensure success.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
What can you expect after
gastric banding?
Recovery takes time and patience.
• Most patients are ready for their first adjustment after eating solid foods
for the first week. The exact timing will depend on your progress.
• If you are losing 1-2 lbs. per week you may not need an
adjustment at that time.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Risks of abdominal surgery
•
•
•
•
•
•
•
•
•
•
Bleeding
Pain
Shoulder pain
Pneumonia
Complications due to anesthesia & medications
Deep vein thrombosis
Injury to stomach, esophagus, or surrounding organs
Infection
Pulmonary embolism
Death
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Risks of bariatric surgery
•
•
•
•
•
•
•
Abdominal hernia
Chest pain
Collapsed lung
Constipation or diarrhea
Dehydration
Enlarged heart
Gallstones, pain from passing a
gallstone, inflammation of the
gallbladder, or surgery to remove the
gallbladder
•
•
•
•
•
Gastrointestinal inflammation or
swelling
Stoma obstruction
Stretching of the stomach
Surgical procedure repeated
Vomiting and nausea
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Summary
Choosing the procedure that’s
right for you
Considerations
• Age
• Obesity related diseases
• Amount of weight to lose
• Lifestyle
• Eating behaviors
Mutual decision between patient and surgeon
• Discuss with surgeon during initial consultation
• Discuss with family and friends
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Setting your expectations
Average Weight Loss
3 Years
Average Weight Loss
5 Years
-0.1%1
-1.6%1
11%2
Not enough data
Excess Weight Loss
3 Years
Excess Weight Loss
5 Years
Gastric bypass surgery
71.2%3
60.5%4
Adjustable gastric banding
66.0%5
49.5%4
Sleeve gastrectomy
55.2%3
29.5%4
Treatment
Diet / Exercise
Drug therapy
Treatment
Percent average weight loss = % of total body weight lost as a result of treatment.
Percent excess weight loss = % of body weight in excess of the ideal body weight that is lost as a result of treatment.
September 26, 2008
Full list of references at end of presentation.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Surgery can help you change your life
•
•
•
Improves or resolves obesity related diseases
Decreases mortality risk
Reduces healthcare utilization and direct healthcare costs
Remember…surgery is a tool that requires your strong
commitment to a lifestyle change and lifetime of follow-up
September 26, 2008
Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of
Surgery 2004;240(3):416-424.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Resolving your obesity related health
conditions
Depression*
Obstructive sleep apnea
47% reduced
45% to 76% resolved
Migraines*
46% improved
Type 2 diabetes
Asthma
45% to 68% resolved
39% improved
High blood pressure
42% to 66% resolved
Urinary stress incontinence*
50% resolved
Nonalcoholic fatty liver disease
37% resolution of steatosis
Osteoarthritis*/
Degenerative joint disease
41% resolved
September 26, 2008
References at end of presentation.
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
* Study population predominantly female.
What are
your next steps?
You’ve already taken the first step

Attend seminar (Complete!)
•
Schedule initial consultation with surgeon
•
Verify benefits and obtain insurance authorization
•
Psychological evaluation
•
Nutritional evaluation & counseling with one of our dieticians
•
Pre-operative testing
•
Surgery
•
Lifelong follow-up appointments and support groups
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Insurance
•
•
•
•
Requirements for approval depend on your policy
Most Require:
• BMI >40 or >35 with significant co-morbidities
• Documented history of medical weight loss attempts (3-6 months)
• 5 year weight history
• Psychological evaluation
• Nutrition counseling
We are here to help you! We will…
• Verify your benefits to ensure coverage
• Review your specific plan requirements with you at your 1st visit
• Submit your documentation for insurance approval for surgery
• Provide examples of documentation required by insurance
However…patients’ active involvement is very helpful in moving
the process along
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Questions
?
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
Contact
(practice to insert contact information here)
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
The information contained in this material is for educational purposes only and
is not a substitute for medical advice. You should talk to your doctor about what
to expect and follow your surgeon's advice regarding activities after surgery.
This presentation has been provided courtesy of Ethicon.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
References for “Many serious health
conditions are related to obesity”
1. Calle EE, Rodriguez C, Walker-Thurmond K. Overweight, obesity, and mortality from cancer in a prospectively studied
cohort of adults. NEJM 2003; 348(17):1625-38.
2. Koenig SM. Pulmonary complications of obesity. Am J Med Sci2001; 321(4):249-279.
3. Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver
disease and the metabolic syndrome. Annals of Surgery 2005; 242(4):610-620
4. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and
obesity in adults. 1998; NIH Publication No. 98-4083.
5. The Obesity Society. What is Obesity. Accessed May 19, 2010 from
http://www.obesity.org/information/what_is_obesity.asp
6. Sugerman HJ, Sugerman EL, Wolfe L, et al. Risks and benefits of gastric bypass in morbidly obese patients with
severe venous stasis disease. Annals of Surgery 2001; 234(1):41-46.
7. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am
Acad Dermatol 2007; 56:901-916.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
References for “Setting your expectations”
1. Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release
phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo controlled, phase 3
extension study. Am J Clin Nutr. 2012;95(2):297-308.
2. Xenical [prescribing information]. South San Francisco, CA: Genentech, Inc.; 2010.
3. Garb J. Bariatric surgery for the treatment of morbid obesity: A meta-analysis of weight loss outcomes for
laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009;19(10):1447-1455.
4. Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects
of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628-637.
5. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and
laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450-1456.
September 26, 2008
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date
References for “Resolving your obesity
related health conditions”
OSA: Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most
popular bariatric procedures. Am J Med. 2008 Oct;121(10):885-93.
Asthma: Reddy RC, Baptist AP, Fan Z, et al. The effects of bariatric surgery on asthma severity. Obes Surg. 2011
Feb;21(2):200-6.
Urinary stress incontinence: Kuruba R, Almahmeed T, Martinez F, et al. Bariatric surgery improves urinary incontinence
in morbidly obese individuals. Surg Obes Relat Dis. 2007 Nov-Dec;3(6):586-90.
Osteoarthritis & Depression: Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y
gastric bypass for morbid obesity. Ann Surg. 2000 Oct;232(4):515-29.
Migraines: Bond DS, Vithiananthan S, Nash JM, et al. Improvement of migraine headaches in severely obese patients
after bariatric surgery. Neurology. 2011 Mar 29;76(13):1135-8.
Type 2 Diabetes: Schauer PR, Sangeeta KR, Wolski K et al. Bariatric Surgery versus Intensive Medical Therapy in
Obese Patients with Diabetes. The New England Journal of Medicine 2012; 366(17):1567‐76.; Adams TD, Davidson LE,
Litwen SE et al.Health Benefits of Gastric Bypass Surgery After 6 Years. JAMA 2012; 308(11): 1122‐1131.; Mingrone G,
Panunzi S, De Gaetano A et al. Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. The New
England Journal of Medicine 2012; 366(17): 1577‐85.; Dorman RB, Serrot FJ, Miller CJ et al. Case‐Matched Outcomes
in Bariatric Surgery Treatment of Type 2 Diabetes in Morbidly Obese Patient. Ann Surg 2012; 255: 287‐293; Tice JA,
Karliner L, Walsh J et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric
Procedures. The American Journal of Medicine 2008: 121(10): 885‐93.; Buchwald H, Avidor Y, Braunwald E et al.
Bariatric Surgery: A Systematic Review and Meta‐ Analysis. JAMA 2004; 292:1724‐1737. Wong SKH, Kong APS, So
WY et al. Use of laparoscopic sleeve gastrectomy and adjustable gastric banding for suboptimally controlled diabetes in
Hong Kong. Diabetes, Obesity and Metabolism 2011; 14(4): 372‐374; Brethauer SA, Hammel JP Schauer PR et al.
Review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Disease
2009; 5: 469‐475.
Hypertension: Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two
most popular bariatric procedures. Am J Med. 2008 Oct;121(10):885-93 and EES analysis of data from US Clinical Trial
PMA 070009.
NAFLD: Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic
26,Oct;242(4):610-7.
2008
fatty liver disease and the metabolic syndrome. AnnSeptember
Surg. 2005
SURGICAL TREATMENTS FOR OBESITY I Surgeon Name(s) I enter date