Download UCLA Bariatric Surgery Program

The UCLA Metabolic &
Bariatric Surgery
Program
www.bariatrics.ucla.edu
July 2008
Introduction
An estimated 97 million adults in the United States are overweight or obese, a
condition that substantially raises the risk of morbidity from hypertension,
dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder
disease, osteoarthritis, sleep apnea, respiratory problems, as well as
endometrial, breast, prostate, and colon cancers. Higher body weights are also
associated with an increase in mortality. As the second leading cause of
preventable death in the United States, overweight or obese poses a major
public health challenge.
The bariatric program is designed to assist people in improving their health and
the quality of their lives by using surgical intervention for weight reduction.
Although bariatric surgery has shown to be an effective tool in weight loss, it is
important for patients to remember that the surgery is only a tool. A successful
outcome is dependent on the patients’ commitment to a long-term lifestyle
change.
There are several methods available for the surgical treatment of obesity. At
UCLA, we perform laparoscopic Roux en-Y Gastric Bypass Surgery,
laparoscopic sleeve gastrectomy in select patients, gastric band removals,
and revisional bariatric surgery on a case-by-case basis. We do not advocate,
perform, or adjust gastric bands, or perform the biliopancreatic
diversion/duodenal switch.
You are encouraged to gather as much information on weight loss surgery by
researching information on the Internet, talking with the team members, and
attending support groups. By developing your own knowledge base about this
treatment method, you will be empowered to reach your goal of long-term weight
loss.
It is encouraged to attend as many support groups as possible prior to and after
surgery including those held outside of UCLA. These meetings will equip you
with information and provide you tools to assist in the life style changes needed
to obtain long-term success.
2
Program Overview
Eligibility Criteria
Patients must meet specific criteria before they will be considered for an
evaluation with our surgeons and internists. Selection is based on guidelines
established by the National Institute of Health, which defines morbid obesity as:
¾ Be a minimum of 100 pounds overweight
¾ Have a Body Mass Index (BMI) of greater than 40, or a BMI of 35
accompanied by other issues related to health (co-morbidities).
¾ Have documented failure of at least one medically supervised
weight reduction programs within the last two years
¾ Generally be between the ages of 18 and 65.
¾ No documented history of bi-polar disease, schizophrenia, and
multiple personality disorders, or other psychoses, which will
interfere with the informed consent, process as well as the ability to
follow instructions. Milder and well controlled forms of bipolar
disease may be considered for sleeve gastrectomy only.
¾ Be physically active
Screening Evaluation
If the patient meets the specified criteria, they must initiate the process by
completing a patient health care questionnaire and obtaining all required
documentation needed for preliminary assessment (See under Getting Started
on page 6). Once all forms have been received at the bariatric office, the
program coordinator will schedule an appointment for consultation with the
surgeon. You will be notified by letter/telephone as to the date and time of this
appointment. Attendance at a UCLA Bariatric Seminar prior to your appointment
date is mandatory. Complete schedule can be found at www.bariatrics.ucla.edu.
Each patient must also obtain a psychotherapy evaluation prior to surgery from
either a psychologist (PhD) or psychiatrist (MD) who specializes in eating
disorders and is familiar with the particular nuances of bariatric surgery. Stress
and emotional eating are considered the Achilles heel of any bariatric surgery. It
is important that you see a mental health professional as soon as possible as
he/she may recommend additional preoperative psychotherapy sessions. We will
provide you with an approved list of providers.
During the surgical consultation appointment, the patient will meet with the
surgeon, program coordinator, and nutritionist. The surgeon will review the
patient’s health history, and conduct an in-depth discussion regarding surgical
techniques and risks. The surgeon will inform the patient of further consultations
or tests needed to determine candidacy for surgery. You will be provided a
3
checklist of pre-operative requirements that must be completed 30 days
prior to having surgery at the latest. All members of the team will review your
case later in the week. You will subsequently be notified of your surgery date and
whether additional material is needed. Bariatric surgery is not always the
appropriate choice, so the screening process assists the team in determining the
best steps for the patient to take
It is strongly advised that you begin completing your pre-operative requirements
as soon as they are identified. The earlier the requirements are achieved the
sooner your surgery will be scheduled.
It is strongly advised that each patient contact their insurance provider to confirm
coverage of bariatric surgery and obtain a list of what their criteria prior to
providing an authorization.
It is also advisable that the patient utilize the list of resources (see end of
packet) to obtain as much knowledge and information prior to the consultation
appointment.
Surgery Preparation
After the patient has been selected as a surgical candidate and has completed
all their prerequisites, the authorization process begins no sooner than one
month prior to your surgery date. Bariatric surgery is usually a covered benefit,
however if a request is denied patients must initiate their own appeal process.
Surgery dates are determined based on the surgeon’s schedule, the hospital’s
operating room availability, and achievement of the defined pre-op weight loss
requirement. Dates are therefore variable and we expect the patients to maintain
a certain degree of flexibility.
You will need to attend 1 or 2 separate pre-op appointments. The program
coordinator schedules these appointments. You will be notified of the time and
date of these appointments once a surgery has been scheduled.
4
¾ The pre-operative appointment with anesthesia. This appointment
takes place at the pre-operative evaluation suite. At this appointment
the patient meets with an anesthesiologist who will review all your
consults and tests. To ensure a safe surgery, additional tests may be
required by them, which can delay your surgery. This may not be
required for all patients
¾ The pre-operative appointment with the bariatric service. This
appointment is mandatory and all efforts are made to schedule it the
same time as your preop appointment. It is at this time you will see your
surgeon again who will perform a physical assessment and further
discuss the surgery with you.
There are many things a patient can do to prepare for surgery. By attending
support group meetings, patients can obtain valuable information by meeting
others who have been, or are going through the same process
Expected Outcomes
Outcome is based on the course of the operation, patient motivation, and patient
compliance with post-operative instructions. The average length of hospital stay
is 2 days. Recovery time at home is approximately 3 to 4 weeks. This is based
on the type of work and each individual’s recovery.
Surgical intervention requires a life-long commitment to dietary and
lifestyle changes. These changes need to occur prior to having surgery.
Dietary changes will be specific to the procedure performed. Examples include
drinking fluids between meals, chewing your food to a liquid consistency prior to
swallowing, and choosing foods high in nutritional value. Lifestyle changes
include increase in daily activities, such as walking, swimming, stretching, and
then gradually adding more as your weight decreases.
What is more significant than just the weight loss is the drastic reduction in the
BMI, with improvements in obesity-related health issues. The literature and our
experience demonstrate a reduction in antihypertensive medications, a decrease
or elimination of oral hyperglycemic agents, and a reduction in insulin doses. The
symptoms of gastric reflux (heartburn) are diminished, and the use of a CPAP
machine for sleep apnea is eliminated.
5
Getting Started
To be considered for surgery you must go through a screening process. Again,
this thorough process is to ensure that bariatric surgery is the best solution for
your health.
We have provided you with the Patient History Questionnaire along with this
packet. It can also be downloaded from our website: www.Bariatrics.ucla.edu.
This form needs to be filled out completely. Return this form along with a copy
of your insurance card, and specific consultation reports (if indicated).
The process is as follows:
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Fill out and return Patient History Questionnaire. Also send copy of
insurance card front and back, and a referral (If indicated)
Questionnaire reviewed to determine eligibility
Patient is contacted stating the consultation appointment date/time, or an
explanation describing why they do not meet criteria and suggested
alternatives
Mandatory attendance at a UCLA Bariatric Surgery seminar before your
initial appointment
Consultation appointment with the surgeon, nutritionist, and the program
coordinator.
Pre-operative visit with nurses and an anesthesiologist (if required)
Pre-op appointment with the surgeon
Surgery
Post-op follow up appointments with surgeon and team.
You will need to schedule your own appointments with the
psychotherapist. See page 3 for more details.
Insurance
Dealing with insurance approval can be a frustrating step in the pre-surgery
process and can take a week to several months. You will require a separate
authorization for each of the following:
9
9
9
9
Consultation appointment with the surgeon
Any specialist the surgeon, or program coordinator refers you to
Surgery
Any follow-up visit with the surgeon after 3 months following surgery
It is important to remember that an authorization for consultation does not
guarantee an authorization for surgery. Once you are seen for consultation, your
surgeon’s office will submit a summary of your appointment, or clinical
information, to your insurance company to determine if you meet medical
6
necessity. Again, it is highly suggested that you contact your insurance company
PRIOR to screening for information about what prerequisites are required to
approve surgery.
If you have PPO insurance, please note that you are required to pay your copayment only during your office visits. You do not require an authorization to see
a specialist. If you have HMO insurance, you are required to contact your
primary care physician (pcp) for a referral/authorization and pay your co-pay at
each office visit.
Checklists
Prior to your consultation:
‰ Obtain insurance authorization/referral
‰ Do research about the surgery. This can be done thru the Internet or
library.
‰ Attend a UCLA Bariatric Seminar.
‰ Fill out and return the Patient History Questionnaire at the end of this
packet. Also enclose a copy of your insurance card.
‰ Obtain any consultation evaluations if indicated.
‰ Make an appointment to see your PCP for one to two weeks after you
have seen us.
What You Need to Bring to the Consultation:
‰ Insurance referral/authorization
‰ Insurance Card
‰ Co-pay
‰ Any questions you may have
‰ A 3 ring binder (for compiling all data regarding the surgery)
Highly Recommended Activities:
‰ Begin losing weight
‰ Begin walking ten to twenty minutes per day
‰ Drink six to eight glasses of water per day
‰ Learn as much as you can about bariatric surgery and what it will mean for
you.
7
Team Members
The UCLA Laparoscopic Bariatric Surgery Program uses a multidisciplinary team
approach to provide resources for the patient. The team members are involved in
all aspects of your journey, from screening through follow-up.
Surgeons
Our surgeons are specially trained in laparoscopic bariatric procedures. At your
screening appointment (s)he will thoroughly explain the procedure to you. It is
expected that you have done extensive research into all available
procedures prior to your appointment and are familiar with the process (i.e.
we expect you to have done your ‘homework’ prior to the initial
appointment).
Amir Mehran, M.D., FACS, FASMBS
Director of Bariatric Surgery
Assistant Clinical Professor of Surgery
Erik Dutson, M.D.
Director of Minimally Invasive & Bariatric Surgery Fellowship
Co-director, Center for Advanced Surgical & Interventional Technology
Assistant Clinical Professor of Surgery
Jessica Folek, M.D.
Clinical Instructor / Fellow
Department of Surgery
Program Manager
The program director is trained in the field of bariatric surgery. She is
responsible for the daily operations of the program, as well as program
development. She is a resource of information for getting prepared for surgery,
providing tools to equip your self for success, and maintain long-term outcomes.
Maria Harrison, B.S.N., C.M.A
Program Manager
8
Program Coordinator
The program coordinator is available to assist patients through the steps of the
surgical process. She is a resource for information regarding the procedure, preoperative instructions, surgery scheduling, appointment scheduling, and
insurance authorization.
Christina Cardenas
Program Coordinator
Administrative Office
Our administrative staff is responsible for the operations of the surgical office
such as new patient appointments and other administrative tasks.
Magdalena Del Real
Administrative Assistant
Nutritionist/ Dietitian
The dietitian oversees the dietary component of patient care. They assist with
preoperative nutritional education, as well as being a resource for behavior
modifications needed for long-term success.
Dana E. Swilley, R.D.
Bariatric Nutritionist
9
About Surgery
Introduction
The UCLA Laparoscopic Bariatric Surgery Program is part of one of the top
medical institutions in the world. Not only can patients be confident that they are
entering a weight reduction program that suits their needs, but also they can be
assured that an experienced surgeon using the latest advances in medicine
performs their surgery.
The surgeons operating at UCLA are committed to excellence and performing
surgery that will ultimately results in the best outcome for patients. Surgeons use
the newest and most innovative techniques and equipment and are highly skilled
in bariatric procedures.
Roux-en-Y Gastric Bypass Surgery
Roux en Y Gastric Bypass Surgery (RYGB) is considered the “gold standard”
of all bariatric surgical procedures. It is a time-tested operation dating back to the
late 1960’s and has shown durable results.
During normal digestion, food moves into the
stomach from the esophagus. While in the
stomach, the food is broken down by juices in
the stomach. This process takes about twenty
to thirty minutes, after which the stomach
contents move to the first segment of small
intestine. Most of the iron and calcium in the
foods we eat is absorbed at this time. The
remaining segments of the small intestine
complete the absorption of almost all calories
and nutrients. The remaining food particles
that cannot be digested in the small intestines
are stored in the large intestine until
eliminated.
The Roux-en-Y operation provides both a restrictive and malabsorptive
modalities for weight loss as both the stomach and small intestines are
reconfigured. First, a “mini stomach” is created by permanently dividing the
stomach, creating a pouch that can hold about 2-3 bites of food. The intestine is
then cut approximately one and one half feet beyond the stomach and is
attached to the pouch to provide an outlet for the food. The pouch gives a
sensation of fullness for a longer period of time. Digestive juices are still
produced in the lower part of the stomach and are released into the intestines
further downstream where they help the food digest. Nutrients and calories can
still be absorbed but in a delayed fashion. Bypassing the distal stomach and
10
proximal intestine, furthermore, alters the normal hormonal milieu, promoting
weight loss in ways that are still being studied.
At ULCA, Roux-en-Y Gastric Bypass Surgery is performed laparoscopically. The
“laparoscopic” approach, also known as “minimally invasive” surgery is
performed through 5-6 small keyhole incisions in the abdomen. The surgeon
uses a camera and several small instruments to perform the surgery. In some
selected cases, the DaVinci Surgical Robot is used to perform the gastric
bypass. Previous abdominal surgeries are not a contraindication to laparoscopic
bariatric surgery in either case. Traditional “open” gastric bypass is rarely
performed and only in cases where the laparoscopic approach becomes
technically impossible to perform safely.
Staged gastric bypass: Sleeve gastrectomy & large pouch RYGB
In very large or high-risk patients, the RYGB
may have to be performed in two stages to
prevent morbidity and even mortality. The two
stage operations include either a sleeve
gastrectomy or less likely, a large pouch gastric
bypass followed by another surgery a few
months later. These options are usually
reserved for patients with very high BMIs or
significant medical comorbidities that preclude a
safe performance of the gastric bypass. They
are both performed laparoscopically, result in a
40-50% excess weight-loss, and are advocated
as a bridge to a more definitive operation, which
can subsequently be done on a ‘healthier’
patient. You doctor may discuss this option with
you.
Which Surgery is right for you?
For patients who remain severely obese after non-surgical approaches to weight
loss have failed, or for patients who have an obesity-related disease, surgery
may be the next best step. The type of surgery you choose is not only a very
personal decision that should be discussed between you and your family, but
also one that requires the professional expertise and knowledge of your surgeon.
Patients who have had surgery require not only close monitoring, but also lifelong use of special foods and medications. Surgery to promote weight loss is a
serious undertaking and typically not reversible.
Remember, there are no guarantees for any method, including surgery, to
produce and maintain weight loss. Success is possible only with your fullest
cooperation and commitment to behavioral change and medical follow-up.
11
Anesthesia
Anesthesiologists are specialists who have graduated from medical school,
completed internship and residency in anesthesiology, and are certified by the
American Board of Anesthesiology. You will meet your anesthesiologists at your
preoperative appointment and on the day of your surgery. They will explain the
procedure, risks, and the side effects. Your surgery will require general
anesthesia. General anesthesia consists of inhaled and intravenous
medications, providing complete pain relief and loss of consciousness. Your
anesthesiologist will be in the operating room throughout the entire procedure
monitoring your condition and managing your vital body functions. After the
anesthesiologist wakes you, they will continue to monitor your care along with
registered nurses in the recovery room.
12
Possible Risks and Complications (partial list)
Bleeding
With any major surgery, bleeding can occur. Documented studies indicate up to a
5% chance. If sufficient blood volume is lost, a transfusion might be necessary.
The need to transfuse is very rare in bariatric surgery and less than 1% will
require a blood transfusion. The risk is somewhat higher in revisional operation
than in first time cases. There is approximately a 1 in 500,000 risk of contracting
AIDS or hepatitis from blood transfusion. Many patients desire to bank their own
blood in anticipation for the need of a transfusion.
Splenectomy
The spleen is a very fragile organ that lies immediately adjacent to the operative
field. It is easily injured and if sufficiently damaged it may need to be removed. It
serves as a filter for the blood, as well as an immune organ. Patients without
spleens generally do quite well, but have increased susceptibility to certain kinds
of infections throughout their lifetime. The risk of this complication is
approximately less than 0.1%.
Anemia
After the gastric bypass operation, anemia is inevitable. The stomach is required
for the normal absorption of iron and vitamin B-12. Because of this, it is
absolutely essential patients undergoing bariatric surgery have life-long
medical follow-up. Generally, a chewable multivitamin with iron is sufficient for
the iron requirement. Additional supplemental vitamin B-12 is necessary. This
can be taking in oral or sublingual form. Routine lab work is necessary to
determine is additional B-12 injections are needed. These injections may need
to be administered every 1-3 months, based on a patient’s symptoms and/or lab
values.
Bowel Obstruction
Any abdominal surgery has the risk of causing bowel obstructions = intestinal
obstructions. This can occur any time in the future and it is caused by scar tissue
formation inside the abdomen. The risk of forming adhesions that can cause an
obstruction is less than 2% and the need for another operation to break up the
adhesion is approximately 1%.
Scarring can form around the loops of the bowel, obstructing them. This results
in pain, nausea and vomiting. It is possible that additional hospitalization or
surgeries might be necessary.
Chronic Diarrhea
Unlike other intestinal bypass operations, severe diarrhea is not a feature of the
gastric bypass operation.
However, there is an occasional patient who
experiences chronic diarrhea lasting a year or more after surgery. This is rare,
being observed in approximately less than 1% of cases.
13
Dumping Syndrome
Some patients may have abdominal pain, cramping, nausea, diarrhea, heart
palpitations, dizziness, loss of consciousness, etc., when sugars and
carbohydrates are ingested. Patients rapidly develop an aversion for these
substances. Symptoms can be quite bothersome in the first few months after
surgery, but generally are fairly minor after that time. You cannot depend on
dumping syndrome to stop you from eating sweets after surgery.
Chronic Nausea and Vomiting
Any time the stomach is operated on, nausea can develop. Nausea can be
significant for several days after surgery and it has been known to be present for
several months after the operation. Vomiting is unusual in gastric bypass
patients. Some vomiting is experienced as new diets are tried the first several
months after surgery, but it is unusual after that period of time. There is an
occasional patient who has problems with vomiting beyond this period of time.
The incidence of this is less than 1%.
Abscess
An abscess is an infection inside the abdominal cavity. When this occurs,
additional operations are often required to drain the infection. Abscesses occur
in approximately ½ % of cases.
Wound Infection
This is more of a complication from open surgery. Abdominal wall fat tissue
heals slowly and tends to get infected. These infections are self-limited and are
easily treated by opening up the skin incision and allowing the wound to heal
from the bottom up. This occurs in approximately 20-40% of open procedure
cases and is rare in laparoscopic procedures.
Incisional Hernia
This is more of issue with open procedures. Hernias are a result of the great
stress on the abdominal incision. This stress can delay the healing process. If
there is poor healing a hernia forms. It occurs in approximately 30-50% of
patients who have an open procedure and generally requires a second operation
to repair the defect after weight loss has been achieved.
Pneumonia
Since obese patients have limited respiratory movements, they are susceptible to
development of pneumonia immediately after abdominal surgery. This occurs in
approximately less than ½% of the cases.
Deep Vein Thrombosis & Pulmonary Embolus
Obese patients have poor blood flow in the legs. When these patients undergo
surgery of any type, blood tends to pool in the legs and clot. These clots can
restrict the venous drainage from the leg resulting in significant leg swelling. This
can become severe and could require treatment with chronic blood thinners.
14
This occurs in less than 1% of cases. Several preventative measures are initiated
prior to your surgery and during your hospital stay.
When a blood clot from the leg breaks loose and travels to the lung, it is called a
pulmonary embolus. Like a deep venous thrombosis, it is a risk of surgery of any
type in the obese and fortunately only occurs in approximately 1% of cases.
Special precautions are taken in the operating room to avoid the development of
deep venous thrombosis of pulmonary emboli. Patients are required to walk
within a few hours after surgery since PE is the number one cause of
postoperative fatality.
Myocardial Infarction and Stroke
The process of being put to sleep and waking up can result in a heart attack or
stroke. Although this can happen, it is extremely rare and tends to be due to
pre-existing medical conditions.
Calcium Deficiency
It has been reported that calcium absorption is limited after gastric bypass
surgery. This can result in bone loss or osteoporosis with resultant fractures. We
recommend supplemental calcium after gastric bypass to avoid the development
of osteoporosis. Calcium levels will be checked routinely.
Irreversibility
The operation is permanent. There is no need to reverse it once weight loss is
achieved. If for some reason you desire reversal, it is important recognize that
the stomach’s function may not return to normal.
Hair Loss
Some patients will experience some thinning of the hair during the first six
months after surgery. This is due to lack of protein supplements in their diet.
This will usually reverse itself after 6 months. Adequate protein intake and biotin
(vitamin B6) supplement is recommended to help with this.
Cigarette Smoking
Patients who smoke are a high risk for surgery. Complications associated with
smoking are: Pneumonia, poor wound healing, pulmonary embolism and death.
Patients MUST discontinue smoking at least 3 months prior to surgery. Nicotine
levels will be checked to document compliance.
Anastomotic Leak
The anastomosis is where the bowels are connected together during the surgery.
There is a risk that leakage of intestinal contents at this location that can result in
serious complications. The most severe is infection and the inability to eat for
many months. This occurs in approximately 1.5% of cases.
15
Marginal Ulceration
There are ulcers that occur in the small intestine of in the pouch following obesity
surgery. They can cause pain and bleeding. Medications or revisional surgery
may be required if this complication occurs. Patients will be given a prescription
for medication to help minimize this potential problem. This medication must be
taken for at least the first months after surgery, longer in some cases. This
medication helps reduce the chance of ulcer development. Approximately 5% of
patient’s experience this complication.
Neuropsychiatric
This is more of an issue with an open procedure. The patient may experience a
stroke, sensory or motor nerve injury or post-operative depression. The
occurrence of this is less than 1 %.
Death
There is an approximately 0.5% incidence of death.
16
Frequently Asked Questions
Q. How long does the surgery take?
A. Approximately 1 ½ - 2 hours for Laparoscopic Roux-en-Y gastric bypass.
Revisional surgeries can last 2-3 times as long.
Q. How soon can I go back to work?
A. On average, patients return to work within four weeks of surgery. Various
factors can affect the length of time, including the type of surgery that has been
performed, job duties, hours worked, length of commute, and the outcome of the
surgery.
Q. I’m concerned about my authorization for my consultation. How can I
ensure that my visit is authorized? What about my approval for surgery?
A. Your initial approval for consultation comes from your primary physician only if
you have HMO type insurance. Obtaining the necessary authorizations is your
responsibility. You cannot be seen by the surgeon without an approval. Please
contact your HMO provider for information. If you have PPO type insurance you
will pay your copay prior to being seen by the surgeon. Another copay will be
required for your appointment with the nutritionist. Once you are seen for
consultation our Program Coordinator will submit your medical notes to your
medical group or insurance company for approval for surgery.
Q. What are my copay's?
A. Your financial obligation for your consultation appointment is your standard copay for office visits or specialist care and can be located on your health insurance
card. To find out about your copay for surgery you will need to contact your
insurance provider by calling the customer service number located on your
insurance card.
Q. I work and will need someone to notify my employer. Who handles
disability forms, leave of absence, and return to work letters?
A. You will need to obtain the disability forms from your employer. Once you
have completed your section, bring them with you at your first post-op
appointment. The doctor will complete the remaining portion. Please notify the
program coordinator as soon as you are given a surgery date if you need a leave
of absence form completed. She will assist you in this. A return to work letter
will be provided as soon as the surgeon says you are allowed to return.
Q. Will I need a blood transfusion during surgery?
A. Unless a patient has severe complications during surgery, which are very rare,
blood transfusions are not needed. You will be asked to sign a consent at your
consultation appointment should a blood transfusion be necessary. It is strictly
precautionary and this right may be waved should you have any religious or
personal prohibitions. You may also opt to donate blood for your surgery for a
fee.
17
Q. Will I have to eat “baby food” type items for the rest of my life?
A. No. The objective is to transition to “regular” food items, with the exception of
fats, sugars, and a greatly reduced meal portion.
Q. How soon after surgery can I get pregnant?
A. It is strongly recommended that birth control be utilized for two years following
bariatric surgery. The maximum weight loss is incurred during the first 2 years of
surgery. Many physical changes occur, caloric intakes change, and new lifestyle
changes begin. Pregnancy requires higher daily caloric intake, and dieting is not
an option. Whereas most pregnancies are uneventful, there have been several
reports of maternal and/or fetal demise with early pregnancy after bariatric
surgery.
Q. Can I use my own nutritionists & primary care MD?
A. No & yes: The nutritionist is an important facet to our program. She is familiar
with the specifics recommended by the professionals involved in our program.
We therefore require you to consult only with our dietician. Your primary
physician, however, is integral to bariatric surgery and must be involved with your
care pre. and post-operatively.
18
Helpful Resources
•
UCLA Bariatric Surgery Program
www.bariatrics.ucla.edu
•
American Society for Bariatric Surgery (ASBS)
www.asbs.org
•
International Federation for the Surgery of Obesity (IFSO)
www.obesity-online.com/ifso
•
American College of Surgeons (ACS)
www.facs.org
•
The North American Association for the Study of Obesity (NAASO)
www.naaso.org
•
National Library of Medicine (NLM), National Institutes of Health
www.nlm.nih.gov
•
National Heart, Lung, and Blood Institute (NHLBI)
www.nhlbi.nih.gov
•
Healthy Eating and Exercise
www.caloriescount.com
•
Online Diet and Fitness Journal
www.fitday.com
•
Obesity Help Online
www.obesityhelp.com
•
Online Dieting Tool
www.dietwatch.com
•
American Obesity Association
www.obesity.org
•
Academy for Eating Disorders
www.aedweb.org
•
Bariatric Support Centers
www.bariatricsupportcenter.com
19
BMI Chart
20
Directions to the Bariatric Consultation Suite
1.
2.
3.
4.
Take the 405 Freeway, Exit Wilshire Boulevard East
Travel East 3 blocks to Westwood Boulevard
Turn left on Westwood Boulevard
Travel 5 blocks, past Le Conte Avenue, look for 3 pink buildings on the
left,
Turn into to the Medical Plaza Entrance
200 Medical Plaza, Suite 214
Clinic Phone Number
(310) 794-7788
Administrative Office Phone Number:
(310) 825-7163
or go to www.mapquest.com for specific directions
21