Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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