Download SSM Health Weight Management Services

SSM Health Weight Management Services
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Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program –
Accredited Center
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We now offer a comprehensive weight loss program designed at fitting the right
weight loss program for you.
Multidisciplinary Team
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Bariatric Coordinator/Clinical Team Lead
Bariatric Nurse Educators
Nurse Practitioner
Director
Registered Dietician
Mental Health Provider
Business Office Supervisor
Surgical Program Team Leader
Patient Advocates / Front Desk Schedulers
Insurance Coordinator
Non-surgical Program Team Lead
Non-surgical Program Health Educator / Coordinator
Non-surgical Program Nurse
The Cause of Obesity
• Not simple
• Many factors have been shown to lead to obesity:
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Metabolic
Hormonal
Increased caloric consumption
Lack of physical activity
Genetic
Obesity = Disease
Medical Complications of Obesity1
Pulmonary Disease
Abnormal Function
Obstructive Sleep Apnea
Hypoventilation Syndrome
Nonalcoholic Fatty
Liver Disease
Steatosis
Steatohepatitis
Cirrhosis
Idiopathic Intracranial Hypertension
Stroke
Cataracts
Coronary Heart
Disease
Diabetes
Dyslipidemia
Hypertension
Gall Bladder Disease
Gynecologic Abnormalities
Abnormal Menses
Infertility
Polycystic Ovarian Syndrome
Osteoarthritis
Skin
Severe Pancreatitis
Cancer
Breast, Uterus, Cervix,
Colon, Esophagus, Pancreas,
Kidney, Prostate
Phlebitis
Venous Stasis
Gout
1. Obesity OnLine slide presentation. Accessed May 17, 2007. Accessible as slide #5 at http://www.obesityonline.org/slides/slide01.cfm?tk=33.
Treatment of Obesity
• Weight loss is not easy
– Significant long term weight loss is often not
successful for many patients
• Aggressive intervention is required for
long-term success
– Diet and exercise are still the foundation
– Tools are needed to help control caloric intake
Benefits of Exercise
• Key part of weight loss and overall health
– Increase muscle mass/metabolic rate
– Suppresses hunger
– Cardiopulmonary benefits
– Prevents weight regain
• Start low and go slow
– 10% rule
• Under medical supervision if other health
concerns
Dietary Changes
• Food Choices
– Lower simple carbs
– Eliminate sweets
– Higher proportion of fat and protein will result in
longer satiety
• Through affecting bodies hormones
• Meal replacements with high protein choices
• Portion Control
• Food Journaling
What’s Your BMI?
Weight (lbs)
120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300
5'0"
Height
5'2"
5'4"
5'6"
5'8"
5'10"
6'0"
6'2"
6'4"
Obesity Categories
Normal Weight
Overweight
Obese
Obese
Extremely Obese
(Class II)
(Class III)
(BMI* 18.5 to
24.9)
(BMI 25 to
29.9)
(Class I)
(BMI 30 to
34.9)
(BMI 35 to
39.9 )
(BMI 40 or
more)
BMI (Body Mass Index): A measurement of an individual’s weight in relation to height (kg/m 2).
National Institutes of Health/National Heart, Lung and Blood Institute Clinical Guidelines Evidence Report. NIH Publication 98-4083, September 1998.
Options for Weight Loss
• Methods to aid in dietary lifestyle changes
– Dietary/Lifestyle Intervention Programs
• Intensive intervention programs
• 10-15% weight loss
– Medications
• 10-15% weight loss
– Surgery
• 20-30% weight loss
• Likely more sustainable than diet programs or
medications but has associated risks
Health Management Resources (HMR) Program
Meal Replacement Based Diet Program
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Decisions Free Diet Option
– 2 options (500-800 cal/day)
• 5 shakes a day or 3 shakes plus 2 entrees
• No other grocery store food
– Medically supervised with weekly education class
– Average weight loss of 57 lbs
• Men lose 3-5 lbs per week
• Women lose 2-4 lbs per week
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Healthy Solutions
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3 Shakes, 2 entrees, 5 servings of fruits and vegetables (1200 cal/day)
Weekly education class with weigh-in
Non-medically supervised
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Except for Patients being treated for diabetes
Average weight loss of 38 lbs
HMR at home
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Have food shipped to you
15-20 lb weight loss
Medical Weight Loss
• Comprehensive program
• Utilizing multiple professionals
– Dietician
– Mental health provider
– Physician
• My utilize medications
• Frequent committed follow-up necessary
Surgical Weight Loss Options
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Duodenal Switch
Roux-en-Y gastric bypass
Sleeve gastrectomy
Adjustable gastric banding
Surgical Qualifications
– BMI of 40 or over
– BMI of 35-40 with significant co-morbidity
• MOST EFFECTIVE OPTION FOR LONG TERM
WEIGHT LOSS
Laparoscopic Weight Loss Surgery
Weight-Loss Surgery
• Restriction
– Adjustable gastric banding
• Restriction with Hormonal Changes
– Sleeve gastrectomy
• Hybrid of restriction and malabsorption
– Roux-en-Y gastric bypass
– Duodenal Switch
Laparoscopic Adjustable Gastric Banding
• Restrictive
• 50% average excess
body weight loss
• Approx. 50 lb weight
loss in person 100 lbs
overweight
• Outpatient surgery
• F/U at 1 week then
monthly for
adjustments
Vertical Sleeve Gastrectomy
• Restrictive with hormonal
changes
• Newest procedure offered
• Has become most commonly
performed procedure in U.S.
• Early 60-65% excess weight
loss or 60-65 lbs in person
100 lbs overweight
• May worsen acid reflux
• 1-2 night stay
• Off work 1-2 weeks
• F/U at 1 wk, 1 mth, 6 mths
then yearly
Roux-en-Y Gastric Bypass
• Combination of restrictive
and malabsorptive
• First done in 1967
• Laparoscopically since 1993
• 75% excess weight loss or 75
lbs in person 100 lbs
overweight
• 1-2 night stay
• Off work 1-2 weeks
• F/U at 1 wk, 1 mth, 6 mths
then yearly
Duodenal Switch
• Combination of restrictive
and super malabsorptive
• 80% excess weight loss or 80
lbs in person 100 lbs
overweight
• High co-morbid resolution
• 2-3 night stay
• F/U at 1 wk, 1 mth, 3mths, 6
mths, 9 mths, 12 mths then
yearly
• NOT all insurances cover this
procedure!
Possible Risks and Complications
Complication
Lap Band
Sleeve gastrectomy
Gastric bypass
Duodenal Switch
Death
Approx 0%
1-2/1000
1-2/1000
3-5/1000
Infection
1-2%
1-2%
1-2%
1-2%
Major bleeding
<1%
2-5%
2-5%
2-5%
Leak
NA
<1%
1-2%
2-3%
GI Issues (nausea,
vomiting, diarrhea)
From complication
of band
More common
early on
Can occur early or
late but severe less
than 5%
Gas and Diarrhea
most common
Erosion of band
<1%
NA
NA
NA
Obstruction
From band slip
From kinking of
sleeve (<1%)
3%, internal hernia
or scar tissue
DVT/PE
Rare
0.5%
0.5%
Stricture/ulcer
NA
<2%
Up to 15% usually if
smoke or use
NSAIDs
Others: need for reoperation, cardiopulmonary dysfunction, kidney dysfunction
Reference: 1. Chapman A, Game P, O’Brien P. Laparoscopic adjustable gastric banding for the treatment of obesity:
update and re-appraisal. ASERNIP-S Report No. 31, Second Edition. Adelaide, South Australia. ASERNIP-S, June
2002.
Orbera® Balloon
• BMI 30-40 kg/m2
• Willingness to participate in comprehensive
weight loss program including physicians,
dieticians, mental health providers and
exercise counselors
• Ability to pay for procedure
• Weight loss 3x as high as diet and exercise
• Average 22lb weight loss in first 6 months
Orbera® Balloon Placement
Orbera® Balloon Removal
The first week with ORBERA™ will be
challenging
Side Effect
Percentage
of Patients
Preferred
Nausea
Team
Vomiting
87%
Abdominal pain
58%
76%
Percentage
of Patients
Patients should expect to feel sick for the first 35 days. In some patients, symptoms may last up
to two weeks
Medications will be prescribed to help address
the symptoms and our support team is available
to help as needed
Source: Directions For Use (DFU). ORBERA™ Intragastric Balloon System
(ORBERA™). Austin, TX: Apollo Endosurgery, Inc.
Orbera® Balloon Complication
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Balloon rupture
Balloon deflation
Inadequate weight loss
Early Removal
Injury to esophagus or stomach
Bowel obstruction
Surgical/Procedural Results
• Average Body Weight Lost
– Adjustable Gastric Banding = 20%
– Sleeve Gastrectomy = 25%
– Roux-en-Y Gastric Bypass = 30%
– Duodenal Switch = 40%
– Gastric Balloon= 10-15%
Average Weight Loss
• Average Body Weight Lost
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Adjustable Gastric Banding = 20%
Sleeve Gastrectomy = 25%
Roux-en-Y Gastric Bypass = 30%
Duodenal Switch = 40%
Gastric Balloon= 10-15%
• Meal Replacement Program – HMR
– 10-20% of weight
• Medications
– 10-15% weight
Benefits of Significant Weight Loss
• Reduction or improvement in co-morbidities
– Reductions in cholesterol, BP, blood sugar, triglycerides, reduced or
completely eliminated medications
• Increased longevity
• Improved Quality of Life
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Health
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Personal
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