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Nutritional Trends and Implications for Weight Loss Surgery

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Learning Objectives:

1. Describe and list the types of bariatric surgeries.

2. Identify current practice guidelines for MNT in bariatrics.

3. Identify key factors in pre-op assessments for long-term success.

Published in: Healthcare
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Nutritional Trends and Implications for Weight Loss Surgery

  1. 1. https://learn.extension.org/events/2550 Nutritional Trends and Implications for Weight Loss Surgery
  2. 2. Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities www.extension.org/militaryfamilies MFLN Intro 2 Sign up for webinar email notifications at www.extension.org/62831
  3. 3. • Received her Masters of Science in Family and Consumer Sciences with a focus in nutrition from Eastern Illinois University. • Currently practicing as a registered licensed Bariatric / Clinical Dietitian at Carle Physician Group. • Professional interests focus on weight management for adults and pediatrics, as well as general nutrition education for the community, including support groups to promote healthy lifestyles. Today’s Presenter 3 Ashley McCartney, MS, RD, LDN
  4. 4. By: Ashley R. McCartney, MS, RD, LDN Carle Physician Group Urbana, IL Ashley.McCartney@carle.com 4
  5. 5. 5
  6. 6. 6 Photo taken from www.stateofobesity.org
  7. 7. 7  Estimate costs range from $147 billion to $210 billion / year.  Associated with job absenteeism  Lower productivity while at work  Obese adults spend 42 percent more on direct healthcare costs than adults who are a healthy weight.  In the U.S., second leading cause of death after tobacco
  8. 8. 8 Photo taken from www.stateofobesity.org/healthcare-costs-obesity/
  9. 9. 9 Classification BMI Risk of Comorbidities Underweight <18.5 Low Normal 18.5 - 24.9 Average Overweight 25.0 - 29.9 Increased Obese Class I 30.0 - 34.9 Moderate Obese Class II 35.0 - 39.9 Severe Obese Class III Super Obese 40.0 – 49.9 >/= 50.0 Very severe Classification of Obesity Photo taken from WHO
  10. 10. 10  Most effective treatment for severe obesity  Resolution of co-morbid conditions  Impact on medication regimen  Impact on metabolic and hormonal changes  Fad / crash / yo-yo dieting does not work  Quick fix? Photos taken from www.reboundfreeweightloss.com and www.globalrugby.com.au
  11. 11. 11 Photo taken from www.happyhungryhealthy.com
  12. 12. 12
  13. 13. 13 Types of Bariatric Surgeries
  14. 14. 14 Photo taken from www.lourdes.com
  15. 15. 15  Restrictive Procedure  First introduced in 1978 by Wilkinson  1986 – current procedure done across the world  FDA approved in 2001  How does the adjustable band function?  Rate of weight loss  Outpatient procedure
  16. 16. 16  Diabetes 50%  Dyslipidemia 50%  Hypertension 60%  Sleep apnea 90%
  17. 17. 17  Band slippage  Leakage of tubing / balloon  Port or band infection  Obstruction  Nausea / vomiting  Band erosion into stomach  Esophageal dilatation  Failure to lose weight
  18. 18. 18  Diet progression  Portion sizes  Vitamin regimen  Physical activity regimen
  19. 19. 19
  20. 20. 20 Filled BandUnfilled Band Photo taken from www.mylapsurgeon.com
  21. 21. 21 Vertical Sleeve Gastrectomy Photo taken fromwww.darylsmarxmd.com
  22. 22. 22  Restrictive Procedure  Irreversible  Popularized in early 2000s  Still under research for efficacy  How does the sleeve function?  Rate of weight loss  Inpatient hospital stay
  23. 23. 23  Diabetes 80%  Dyslipidemia 60%  Hypertension 60%  Sleep apnea 95%
  24. 24. 24  Leaks 1-2%  Strictures <1%
  25. 25. 25  Diet progression  Portion sizes  Vitamin regimen  Physical activity regimen
  26. 26. 26
  27. 27. 27 Bile duct Pancreas Descending duodenum Food absorbed Mouth Proximal gastric pouch To rest of bowel Jejunum Photo taken from www.browardsurgicalspecialists.com
  28. 28. 28  Malabsorptive procedure  Reversible  Developed in the 1960s  How it functions  Rate of weight loss  Why is bypass considered “the gold standard?”  Inpatient hospital stay
  29. 29. 29  Diabetes 90%  Dyslipidemia 70%  Hypertension 65%  Sleep apnea 90%  Reflux 98%
  30. 30. 30  Diet progression  Portion sizes  Vitamin regimen  Physical activity regimen
  31. 31. 31
  32. 32. 32
  33. 33. 33  Preoperative weight loss prior to surgery  Lap band rate of weight loss  Sleeve gastrectomy rate of weight loss  Gastric bypass rate of weight loss
  34. 34. 34
  35. 35. 35 Photos taken from www.bariatricnews.netand www.binghammemorial.org
  36. 36. 36  No deaths  10% SAE’s  19% had balloon removed early  Nausea, vomiting, abdominal pain, reflux in 48-72 hrs.
  37. 37. 37  BMI 30-40  In conjunction with long term diet/behavior modification program  Failed more conservative teatments  Maximum duration of placement 6 mos.
  38. 38. 38  Reasonable option for temporary weight loss  Very skeptical about long term weight loss efficacy  High potential for inappropriate use  Most beneficial indications are currently off- label
  39. 39. 39  Biliopancreatic diversion  Biliopancreatic diversion with duodenal switch  Silastic ring gastric bypass  Endoscopic sleeve gastroplasty  Vbloc  AspireAssist
  40. 40. 40 Photo taken from www.drsamuelbledsoe.com
  41. 41. 41 Expected Outcomes References First Trimester Second Trimester Third Trimester Post-Partum Close collaborative efforts between the bariatric surgeon and obstetrician. Patient must notify office as soon as pregnancy is confirmed and appointment made for fluid removal. All fluid will be removed to minimize restriction of band. A band fill will be performed no earlier than 14 weeks gestation or later if weight gain is excessive. All fluid will be removed from the band at 36 weeks gestation. A band fill will not be performed until lactation is established. Band adjustment will likely be close to pre- pregnancy levels. Maintain healthy fetal development. Minimize risks associated with obesity, pregnancy and poor neonatal outcomes through weight management. Fluid removal will allow for optimal nutritional intake during embryogenesis and minimize risk for hyperemesis during the first trimester. Based on IOM weight gain recommendations, the band fills will be performed to minimize excessive weight gain (not to promote weight loss). Recommendations for weight gain are based on varying BMI levels and are to be determined by obstetrician. Management of band will be based on weight gain recommendations. Reduce impact of band on delivery. Initiate weight loss or weight maintenance. Dixon, J. B., Dixon, M. E., & O'Brien, P. E. (2001). Pregnancy after lap-band surgery: Management of the band to achieve healthy weight outcomes. Obesity Surgery, (11), 59-65.             Carle Foundation Hospital:
  42. 42. 42  Timing of pregnancy  Recommended lab work  Protein requirements  Weight gain
  43. 43. 43  Surgery for pregnancy  Sports nutrition- i.e. marathons, etc.  Surgery for other medical procedures Photos from: www.7leafmarketing.com www.karatebyjesse.com
  44. 44. 44  "The State of Obesity: Obesity Data Trends and Policy Analysis." The State of Obesity: Obesity Data Trends and Policy Analysis. N.p., n.d. Web. 1 Apr. 2016.  Allison DB, Fontaine KR, Manson JE, Stevens, J, Vanitallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16)1530-8.  Cawley J and Meyerhoefer C. The Medical Care Costs of Obesity: An Instrumental Variables Approach. Journal of Health Economics, 31(1): 219-230, 2012; And Finkelstein, Trogdon, Cohen, et al. Annual Medical Spending Attributable to Obesity. Health Affairs, 2009.  Cawley J, Rizzo JA, Haas K. Occupation-specific Absenteeism Costs Associated with Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49(12):1317?24, 2007.  Gates D, Succop P, Brehm B, et al. Obesity and presenteeism: The impact of body mass index on workplace productivity. J Occ Envir Med, 50(1):39-45, 2008.  Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable to Obesity: Payer-and Service-Specific Estimates. Health Affairs, 28(5): w822-831, 2009.  Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric Surgery. A systematic review and meta-analysis. JAMA. 2004  Oria, HE. Gastric banding for morbid obesity. Eur J Gastroenterol Hepatol 1999;11:105-114  Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12:564-568.  Saber AA, Elgamel MH, McLeod, MK. Bariatric surgery: the past, present and future. Obesity Surgery Including Laparoscopy and Allied Care, 2008;18(1):121-8  Weight Control Information Network, National Institutes of Health. Bariatric surgery as a treatment for obesity. National Institute of Diabetes and Digestive and Kidney Diseases. 2011, June. Accessed August 30, 2012 from http://win.niddk.nih.gov/publications/gastric.htm  Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12:564-568.  Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1): 70-89 [Research Support, Non- U.S. Gov’t Review.]  Dixon, J. B., Dixon, M. E., & O'Brien, P. E. (2001). Pregnancy after lap band surgery: Management of the band to achieve healthy weight outcomes. Obesity Surgery, (11), 59-65.
  45. 45. What is one significant thing  you learned today? 45
  46. 46. Connect with MFLN Nutrition & Wellness Online! MFLN Nutrition @MFLNNW MFLN Nutrition and Wellness MFLN Nutrition and Wellness NW SMS icons 46
  47. 47. MFLN Intro 47 We invite MFLN Service Provider Partners to our private LinkedIn Group! https://www.linkedin.com/groups/8409844 DoD Branch Services Reserve Guard Cooperative Extension
  48. 48. Evaluation and CPEUs • MFLN Nutrition and Wellness CA is offering 1.0 CPEU for today’s webinar. • To receive credits, please complete the evaluation at: https://vte.co1.qualtrics.com/jfe/form/SV_2607el0rTJo86Lr 48
  49. 49. Nutrition and Wellness Upcoming Event Nutrition, Exercise, and Renal Disease •Date: Tuesday, June 28, 2016 •Time: 11:00 am Eastern •Location: https://learn.extension.org/events/2655 For more information on MFLN Nutrition and Wellness go to: https://blogs.extension.org/militaryfamilies/nutrition-and- wellness/ 49
  50. 50. www.extension.org/62581 50

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