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SSM Health Weight Management Services • Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program – Accredited Center • We now offer a comprehensive weight loss program designed at fitting the right weight loss program for you. Multidisciplinary Team • • • • • • • • • • • • • 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: – – – – – 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 • 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 • Healthy Solutions – – – 3 Shakes, 2 entrees, 5 servings of fruits and vegetables (1200 cal/day) Weekly education class with weigh-in Non-medically supervised • • • Except for Patients being treated for diabetes Average weight loss of 38 lbs HMR at home – – 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 • • • • • 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 • • • • • • 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 – – – – – 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 – – – – Health Social Personal Work QUESTIONS?