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DISCOVER
Hope and Help for Obesity
SURGICAL WEIGHT LOSS SEMINAR
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DISCOVER
Hope and Help for Obesity
“The Path To Your New
Life”
DISCOVER
Hope and Help for Obesity
INTRODUCTIONS
Quality Multi-Disciplinary Team
Medical Director: Aaryan Koura, MD - Board
Certified General Surgeon
Program Director: Rondi Crowley, RN - Director of
Surgical Services
Program Coordinator: Terri Smith
Program Dietitian: Randee Reidy, RD - Experienced
Registered Dietitian with 9+ years experience in
Bariatric and Weight Loss Surgery Patients
Quality Director: Candace Lawson, MD - Family
Practice Physician with emphasis on Bariatric
Medicine
DISCOVER
Hope and Help for Obesity
WHY CONSIDER SURGICAL WEIGHT
LOSS ?
 It has been proven to be the most effective way to
lose weight and keep it off “long term”
 Surgery is the only approach that provides
consistent, permanent weight loss for patients with
chronic morbid obesity
DISCOVER
Hope and Help for Obesity
What Does “ASBS Stand For?
AMERICAN SOCIETY FOR BARIATRIC
SURGERY
A group of physicians and allied healthcare
professionals who united in order to provide
research, information, consistency, and
improvements to surgical weight loss patients.
Methodist’s program follows their guidelines
DISCOVER
Hope and Help for Obesity
WHAT IS “BMI”?
Body Mass Index
A calculation that gives an estimate of a person’s body fat
based on a relationship between weight and height.
 250 lbs at 6’2”
BMI is 32
 250 lbs at 5’2”
BMI is 46
 400 lbs at 6’2”
BMI is 52
 400 lbs at 5’2”
BMI is 73
DISCOVER
Hope and Help for Obesity
Body Mass Index
<18.5
Possibly Underweight
18.6 - 24.9
Healthy Range
25 - 29.9
Overweight
>30
Obese
>40
Morbid Obesity
This may not be an accurate measurement tool if you are pregnant,
a body builder or an athlete
SAMPLE BMI CHART
BMI
36
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
Height in Inches
58 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258
59 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267
60 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276
61 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285
62 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295
63 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304
64 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314
65 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324
66 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334
67 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344
68 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354
69 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365
70 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376
71 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386
72 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397
73 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408
74 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420
75 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431
76 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443
DISCOVER
Hope and Help for Obesity
WHAT ARE CO-MORBIDITIES?
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Type 2 Diabetes
Hypertension
Osteoarthritis
Hyperlipidemia (High Cholesterol)
Sleep Apnea
Gastric Esophageal Reflux Disease (GERD)
Many others
DISCOVER
Hope and Help for Obesity
WHO IS A CANDIDATE FOR OUR
PROGRAM?
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BMI 40-60 with or without co-morbidities
BMI between 35-39 with co-morbidities
Failed attempts at significant weight-loss long term
Family/Friends support system in place
No major psychological disorders
Good understanding of risks
Good understanding of necessary dietary changes
DISCOVER
Hope and Help for Obesity
Terri Smith
Bariatric Coordinator
Can you commit to the
Life Style Changes?
 Motivation!!!
 Nutrition
 Supplements
 Exercise
 Mind (Is is the right
time for you to begin
a MAJOR lifechanging event?)
 Ongoing Support
Group Attendance!
General Program Requirements ~
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Seminar Attendance
Support Group Attendance
Letter of Medical Necessity from Primary Care Physician
Recent History and Physical
Gallbladder Ultrasound
Upper Endoscopy or Upper GI (depending on surgery type)
Lab Work (CBC, Lipid, Chem, Thyroid, Thiamine, etc)
EKG
Chest x-ray
Psychological Evaluation
Dietician Classes (Pre and Post-op with our dietician)
Women Patients of
Childbearing Age:
You MUST commit
to not getting
pregnant for AT
LEAST 18 MONTHS
post-op gastric
bypass or the LapBand procedure!
®
One More Thing...
 YOU MUST QUIT
SMOKING PRIOR TO
WEIGHT LOSS
SURGERY!
 This surgery is a
lifestyle change to
get healthy..so get
healthy in all aspects
of your life!
 Smoking is an
addiction. Bariatric
surgery is about
getting control!
STEPS TO SURGERY
Jumping Over The Hurdles!
1.
2.
3.
4.
5.
6.
7.
8.
9.
Complete Intake Form / Attend Seminar
Face - to - face interview with Terri to
discuss pre-surgical weight loss, surgery
options, etc.
Pre-surgical dietician class #1 (Group
Class)
Begin pre-op weight loss / smoking
cessation / medical tests / psychological
evaluation
2nd Pre-op Dietician Appointment
(Individual consult)
Complete Chart to Medical Review
Appointment with Dr. Koura
Authorization for surgery prepared
Pre-op appointment with surgeon
10. Surgery!
THE IMPORTANCE OF
PRE-SURGICAL WEIGHT LOSS
INITIAL GOAL IS A 10% REDUCTION
Risk Reduction
Blood Sugar, Blood Pressure, Lung Improvement
Ease if surgery increased due to loss of fat “on the inside”
Dietary changes
Identify abnormal eating patterns and behaviors pre-op
Education regarding healthy nutrition
INSURANCE DENIALS
Weight Loss Programs &
Diets
 Organized programs such as
Weight Watchers, Jenny Craig,
TOPS)
 “Trendy” Diets (Atkins, South
Beach, Sugarbusters)
 Self Diets (Cabbage Soup,
Grapefruit)
 Non-Prescription Medications
(Dexatrim, Metabolife)
Medically Supervised Diet
(by primary M.D., dietician, and/or
exercise physiologist)
 One which is supervised by a
healthcare provider.
 This may include
dietician/nutritional counseling
and/or prescription medications.
 Periodic weigh-in are performed.
 DOCUMENTATION IS THE KEY!!!
Your Financial Investment
This may not apply if you have an HMO insurance plan
Variable Expenses: (May be covered under your
Insurance plan)
 Psychological Evaluation ($150-500)
 Fixed Expense:
 Dietician Classes ($135 for 2 pre-op sessions)
 *****Additional sessions may need to be
taken at an additional fee
 Program / Surgeon Administrative Fee ($500)
(Please discuss all expenses further at personal meeting
with Bariatric Coordinator)
Additionally...
Remember, you will need quality vitamins each month,
and initially protein supplements.
We do not endorse any particular product, but will give you
recommendations for supplements and protein drinks.
Protein drinks are temporary, supplements are for life!
You will save money on medications, groceries, and eating out but you will also need to purchase high quality food.
Allow for this in your monthly budget.
Something to consider
Some patients may need plastic surgery or “reconstructive
surgery” following weight loss surgery. Not all insurance
companies will cover this, or they may cover a portion of a
procedure, but not another.
Excess skin can be a major concern for some patients.
Exercise will NOT get rid of it. You can tone muscle, but not
skin. For this reason, please have realistic expectations about
what your body may look like after surgery, and if you think
that you will want or need cosmetic surgery, start planning for
it financially.
Focus on your health, not your vanity.
STEPS TO SUCCESS
WEIGHT LOSS IS SUCCESSFUL WHEN A
PATIENT HAS A:
 Commitment to “Life Style Modifications” Quality VS.
Quantity, Increase activity
 Commitment to “Partnering With Others” Family and
friends need to be involved in this decision, Support Groups
are critical to your success
 Commitment to “Medical,Nutritional, & Behavioral
Follow-up” Long Term Get reconnected with the dietician,
keep taking vitamins - Attend Support Group Meetings!
In Addition - Remember...
 Surgery is successful when a patient has
lost all or most of the co-morbid conditions
caused by obesity.
 Medications are no longer needed.
 Don’t get fixed on a specific number
(WEIGHT) or size.
 “It’s not how fat you are - it’s how FIT you
are!” Dr. Thomas Hopkins, Internist and Bariatric Specialist
Terri Smith, Bariatric Coordinator
 Roux-en-y gastric bypass
in February 2001
 Committed to life-style
changes
 Support system in place
 Remember. . . This is
JUST a tool!
Christmas 2000 - 6 weeks pre-op
DISCOVER
Hope and Help for Obesity
NUTRITIONAL
PRESENTATION
RANDEE REIDY
REGISTERED DIETITIAN
DISCOVER
Hope and Help for Obesity
NUTRITIONAL RISKS
 Excessive vomiting/dehydration
 Protein or calorie malnutrition, can happen with both
surgeries
 Poor absorption of specific nutrients such as iron, calcium
and B12 -- Can result in anemias, osteoporosis, osteopenia
 Folate, Thiamine, or other B vitamin deficiencies
 Larger issue with Roux en Y than with Adjustable Lap- Band®
THE IMPORTANCE OF PROTEIN
PROTEIN: Why?
 Improves wound healing
 Helps preserve Lean Body
Mass (LBM)
 Protein provides the
building blocks of all cells
 Helps maintain immune
system
PROTEIN: How Much?
 Variable - usually
between 60 and 100
grams per day
 Men and women have
different requirements
 Dietitian will calculate
your needs
DISCOVER
Hope and Help for Obesity
BEST PROTEIN SOURCES:
 Eggs (whites), seafood, poultry, soy, tofu
 Dairy Products if tolerated
 Eventually include pork, beef (May not be well
tolerated at first)
 Liquid Protein Supplements necessary at first to
meet your protein needs
DISCOVER
Hope and Help for Obesity
CARBOHYDRATES
 Fruits and vegetables
 Whole grains
 Legumes
 Avoid refined sugars and carbohydrates (Processed
flours, breads, crackers, table sugar, high fructose
corn syrup)
DISCOVER
Hope and Help for Obesity
FATS
 Use sparingly
 Low fat diet for weight loss and maintenance
 Include essential fatty acids, Omega 3’s, 6’s
 (fish, nuts, olive oil, canola oil)
 Vitamins A, D, E, K (fat soluble vitamins)
LACTOSE INTOLERANCE
Gas, Bloating Cramping,
Diarrhea
 Usually only brought on with
Roux en Y, not Lap Band, may
be temporary
 Some foods may be tolerated
such as yogurt, cheeses, soy
milk, and Lactaid® products
 Estimated that 23% of patients
cannot tolerate dairy products
after surgery
DISCOVER
Hope and Help for Obesity
FLUIDS-HOW MUCH and WHAT TYPE?
 Initial goal: (48-64 oz) per day
 Sip slowly, 4 oz per hour
 Non-caloric, non-carbonated, and
decaffeinated beverages
 WATER IS THE BEST!
 Avoid fruit juice (full strength) and alcohol
 Do not drink with your meals. Allow 30
minutes before and 30 minutes after
eating
 Sip fluids throughout the day
DISCOVER
Hope and Help for Obesity
DUMPING SYNDROME
Usually only happens with Roux en Y
Usual Cause: High Sugar or High Fat foods
 Caused by rapid emptying of stomach contents into intestine
 Abdominal cramping or diarrhea
 Nausea, lightheadedness, flushing
 Occurs most often during early postoperative period
DISCOVER
Hope and Help for Obesity
CONSTIPATION: How to prevent:
(Can happen with both surgeries)
Increase water intake
Increase walking
Increase fruits, vegetables, whole grains and
legumes
May need fiber supplements or stool
softeners, but only when advised by your
surgeon
VOMITING: Happens
with both surgeries -Why?
 Eating too fast, too large of
bite
 Not chewing food properly
 Food too dry
 Drinking fluids with meals
 Too quick progression with
diet
 Reclining too soon after a
meal
Food Getting Stuck
 Learn when you are “full”
 Do not overeat
 Chew food very well (2030 chews per bite)
 Avoid dry foods
 Stand and walk after
eating a meal
MEAL GUIDELINES:
Basics
 Plan meal times
 Greatly limit restaurant
eating
 Drink between meals, not
with meals
 Use portion control, use
smaller plate
 Chew food very well
 Do not over eat, know your
pouch size
 Eat Protein first
 Learn when you have had
enough
 Eat slowly
 Eat without distractions
 Make wise and healthy
choices
DISCOVER
Hope and Help for Obesity
SUPPLEMENTS
 Required for life
 Multivitamin, Calcium, B12, other B vitamins, Iron
 Needs somewhat vary depending on gender, age,
AND surgical procedure
 REMEMBER – DO YOUR BEST WITH YOUR FOOD!!
DISCOVER
Hope and Help for Obesity
THE SURGERY
Aaryan N. Koura, MD
The Formula For Success:
1/4= Surgical Procedure
1/4= Program/Dietician
and Support Group
1/2= YOU!!!!!!!!!
IS THERE A CURE FOR
OBESITY?
There is NO miracle cure
For patients with chronic morbid obesity
long-term *Quick Fixes” don’t last
“DECLARING BANKRUPTCY”
A chance for a fresh start
Roux-En-Y Gastric Bypass
 Restrictive and
malabsorptive procedure.
 Current “Gold Standard”
surgery for weight loss,
per the National Institutes
of Health.
 Proven Safe and Effective
for long-term weight loss
 Not reversible
 Covered by most
insurance plans
Adjustable Lap Band® System
 Restrictive Procedure
 Performed laparoscopically
 Least invasive surgical weight
loss procedure
 Can easily be adjusted and
removed
 Initial weight loss may be
slower
 Long term results (5 years),
results are the same as the
Roux-En-Y Gastric Bypass
 Still some resistance from
insurance companies, but this
is improving.
RISKS OF SURGERY
Roux en Y Gastric Bypass
Adjustable Lap Band
• Standard risks associated with • Standard risks associated with
major surgery (Blood clots,
major surgery (Blood clots,
anesthetic reaction, death)
anesthetic reaction, death)
• Nausea and Vomiting
• Nausea and Vomiting
• Leak at staple line (may require
• Band slippage (May require
additional surgery)
additional surgery
• Narrowing at the anastomosis
• Band erosion (May require
(connection) (May require minor
®
procedure)
• Nutritional Deficiencies
additional surgery)
• Access Port Problems
Thank you for attending~
Questions?