Is Bariatric Surgery Right For You?

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Bariatric surgery can be a lifesaving procedure, but there are many factors to weigh. If you or a loved one are considering the procedure, Dr. Warner presents this informative program. She reviews the criteria and commitment required to undergo this type of surgery, the surgical options, as well as the potential outcomes and health benefits.

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  • Severe Obesity = Class III Obesity or Class II Obesity + comorbidities
  • HTN- Present in approximately half of obese patients
    DM- >80% of type II diabetes can be attributed to obesity
    Cardiac disease-
    Kidney disease- mainly due to effects of HTN and Diabetes
    OSA-
    OA-most commonly in the knees and ankles
    Cholelithiasis-
    Infection- Skin, soft tissue, respiratory, and perioperative
    GERD
    Stroke
    DVT
    Death- BMI 30-35, survivial reduced by 2-4 years. BMI 40-45, survivial reduced by 8-10 years.
    Increased all-cause mortality in overweight and obese patients. BMI at baseline. Adjusted for age, physical activity, alcohol consumption, education, and marital status. Healthy patients with a BMI >40 were 2.5-2.9 times more likely to die than their normal weight counterparts.
  • We are now a country that is overweight and malnourished.
  • All of these procedures are done laparoscopically.
  • Rapid weight loss:
    For gastric bypass, 10-15lbs/month for first 6 months, then 5-7lbs/month for following 6 months. Weight loss reaches a plateau at 12 months after surgery. Average weight loss 100-120 lbs.
    For gastric band, 1lb/week until stabilization at ~2 years.
    Diabetes:
    In a head to head trial, bariatric surgery is better than medical management for control of diabetes and has actually been shown to reverse diabetes.
    The mechanism of diabetes reversal is often not dependent on weight loss.
    HTN:
    HTN improvement is weight loss dependent: resolution at 23% at 30 days, 40% at 6 months, 50% at 1 year.
    Hyperlipidemia:
    At one year: Total cholesterol decreased 16%, TG decreased 63%, LDL decreased 31%, HDL increased 39%.
    80% no longer require lipid lowering medications.
    OSA: 80% have improvement or resolution of OSA.
    GERD: 70% of patients have improvement or resolution of GERD following gastric bypass.
    Sleeve does not significantly improve GERD symptoms. 9% of patients who didn’t have GERD symptoms develop them.
    PCOS/Infertility: 70% of women who were infertile prior to bariatric procedure have gone on to have successful pregnancies.
  • Is Bariatric Surgery Right For You?

    1. 1. Bariatrics & Beyond Elizabeth A. Warner, MD General & Bariatric Surgery
    2. 2. www.SpringfieldClinic.com/DoctorIsIn
    3. 3. Outline • What is Obesity? (Calculate your BMI) • Obesity Trends in U.S. • Obesity Comorbidities • Cause of Obesity • Bariatric Surgery Options and Benefits • Candidates for Bariatric Surgery • Bariatric Surgery Program Components
    4. 4. What is Obesity? • Body Mass Index (BMI) = • Weight Categories: • Underweight- BMI <18.5 • Normal weight- BMI ≥18.5-24.9 • Overweight- BMI 25-29.9 • Obese- BMI ≥30 • Class I- BMI 30-34.9 • Class II- BMI 35-39.9 • Class III- BMI ≥40 • Super obese- BMI >50 Weight (kg) Height (m)2
    5. 5. BMI Real Life Example 5’4” 120lbs: BMI 20.6 140lbs: BMI 24 160lbs: BMI 27.4 180lbs: BMI 30.9 200lbs: BMI 34.3 220lbs: BMI 37.7 240lbs: BMI 41.1 260lbs: BMI 44.6 280lbs: BMI 48 5’9½” 120lbs: BMI 17.4 140lbs: BMI 20.4 160lbs: BMI 23.3 180lbs: BMI 26.2 200lbs: BMI 29.1 220lbs: BMI 32 240lbs: BMI 34.9 260lbs: BMI 37.8 280lbs: BMI 40.7 Underweight <18.5 Normal weight ≥18.5-24.9 Overweight 25-29.9 Obese- ≥30 Class I- 30-34.9 Class II- 35-39.9 Class III- ≥40 Super obese- >50
    6. 6. Obesity Trends Among U.S. Adults 1985 http://www.cdc.gov/obesity/data/adult.html
    7. 7. Obesity Trends Among U.S. Adults 1990 http://www.cdc.gov/obesity/data/adult.html
    8. 8. Obesity Trends Among U.S. Adults 1995 http://www.cdc.gov/obesity/data/adult.html
    9. 9. Obesity Trends Among U.S. Adults 2000 http://www.cdc.gov/obesity/data/adult.html
    10. 10. Obesity Trends Among U.S. Adults 2005 http://www.cdc.gov/obesity/data/adult.html
    11. 11. Obesity Trends Among U.S. Adults 2010 http://www.cdc.gov/obesity/data/adult.html
    12. 12. Why do physicians care about obesity? • Hypertension • Diabetes • Coronary artery disease • Heart failure • Atrial fibrillation • Kidney disease • Obstructive sleep apnea • Osteoarthritis • Cholelithiasis • Infection • GERD • PCOS, Infertility • Sexual dysfunction • Urinary incontinence • Hepatic steatosis (“fatty liver”) • Stroke • Cancer: Esophagus, stomach, colon, rectum, liver, gallbladder, pancreas, kidney, breast, prostate, uterus, cervix, ovarian, lymphoma, multiple myeloma • Death (all-cause and cardiac)
    13. 13. What causes obesity? • Calories In • Calories Out • Metabolism • Muscle mass • Genetics • Microbiome • Stress • Sleep
    14. 14. Calories In (Eating) • Hyperpalatable foods • Salt-Sugar-Fat • Bliss point • Standard American Diet (S.A.D.) • Convenient, Low cost • Highly processed • Devoid of micronutrients and fiber Sugar 4g of sugar = 1 tsp of sugar 12oz coke: 38.5g of sugar 8oz grape juice: 40g of sugar 8oz apple juice: 28g of sugar 8oz orange juice: 26g of sugar
    15. 15. Calories Out (Activity) • Calorie Expenditure • Aerobics (low impact) 272kcal • Bicycling (10mph) 327kcal • Bowling 163kcal • Housework 163kcal • Jogging (6mph) 544kcal • Stair climbing 435kcal • Vacuuming 191kcal • Walking (3mph) 180kcal • Washing the car 163kcal • Sleeping 49kcal • Watching television 54kcal • Driving 109kcal • Standing 65kcal • Grocery shopping 125kcal www.caloriesperhour.com
    16. 16. Prevention Is Key • Establish healthy eating habits early for children • The majority of meals should be made at home • Be mindful of gradual weight gain and make adjustments before the problem feels overwhelming – Once a week weigh in – Clamp down on diet and increase activity • Consistency (diet & exercise) is mandatory
    17. 17. Dr. Warner’s Quick Tips • No soda or juice (Liquid calories = NEVER foods) • Increase your fruit & vegetable consumption • Decrease your processed food consumption • Eat at least one green thing per day • Keep a food journal • Start to read labels and educate yourself • Get the ‘bad for you food’ out of the house
    18. 18. Bariatric Surgery Options Gastric Bypass Sleeve Gastrectomy Gastric Band
    19. 19. Bariatric Surgery Benefits • Rapid weight loss – 70% EBW Gastric Bypass (~1 year) – 60% EBW Sleeve Gastrectomy (~1 year) – 50% EBW Gastric Band (~2 years) • Improvement in comorbidities – Diabetes – Hypertension – Obstructive Sleep Apnea – GERD – Infertility
    20. 20. MMC Bariatric Surgery Benefits at 5 Years
    21. 21. Bariatric Surgery- Who is a candidate? • Body Mass Index (BMI) = • Weight Categories: • Underweight- BMI <18.5 • Normal weight- BMI ≥18.5-24.9 • Overweight- BMI 25-29.9 • Obese- BMI ≥30 • Class I- BMI 30-34.9 • Class II- BMI 35-39.9 • Class III- BMI ≥40 • Super obese- BMI >50 Weight (kg) Height (m)2
    22. 22. Memorial Bariatric Surgery Program • Springfield Clinic partnership with Memorial Hospital • Multidisciplinary Program: • Medical evaluation and education • Medical candidacy • Procedure choice • Nutritional evaluation and education • Physical therapy evaluation and education • Fitness assessment • Personalized exercise program • Psychological evaluation and support • Monthly support groups • Long-term follow-up
    23. 23. More Information www.MemorialBariatricServices.com www.SpringfieldClinic.com

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