Seminar web presentation

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  • More tell-tale image / no sleeveless
  • Continue to speak to the patient not being alone in this challenge
  • An opportunity to speak to the formula BMI= Weight(kg) / Height (m) 2 . Great chance to get the participants involved - create an example using the BMI wheel that has been distributed.
  • Speak to being able to do the simple things.
  • See adjustable gastric banding NOT CORRECT PICTURE
  • See adjustable gastric banding Need references
  • From NJ presentation
  • We could add a slide here showing the resolution of co-morbidities.
  • Fill in information pertaining to your practice.
  • Seminar web presentation

    1. 1. Dr. Terry Scarborough & Dr. Sherman Yu Is weight- loss surgery the answer for you?
    2. 2. 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, 2008Texas Laparoscopic Consultants, LLP April 2009
    3. 3. Welcome to TLC Surgery• We are an entire practice dedicated to helping you succeed with weight loss surgery and living a longer, happier, healthier life!• A multi-disciplinary Bariatric focused practice• Lead by 2 fellowship trained, board certified Surgeons• Nutritionists• Psychologist• Insurance Specialists September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    4. 4. How obesitycan affectyou
    5. 5. Many factors influence obesity OBESIT Y September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    6. 6. Obesity is… …a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.It is also…• multi-factorial (many different factors can cause obesity)• life-long• progressive• potentially life-threatening September 26, 2008• costlyTexas Laparoscopic Consultants, LLP April 2009
    7. 7. How do we measure obesity?According to the National Institute of Health –Body Mass Index (BMI) is a measure of body fat based onheight and weight that applies to both adult men and women BMI Indicators Healthy Range 18.5 – 24.9 Overweight 25.0 – 29.9 Obese 30.0 – 34.9 Severe Obesity 35.0 – 39.9 Morbid Obesity 40.0 – 49.9 Super-Morbid Obesity > 50 September 26, 2008 NHLBI 2000 (NIH), Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in AdultsTexas Laparoscopic Consultants, LLP April 2009
    8. 8. Many serious illnesses areassociated with obesity• Type-2 Diabetes1,3 • Gastroesophageal reflux disease• Hypertension1,3 (GERD)2,3• Hyperlipidemia 1,3 • Degenerative joint disease (DJD)3• Respiratory disease1,3 • Heart disease 2• Sleep apnea1,2,3 • Gallstones1,2,3• Depression3 • Fatty liver disease2,3• Menstrual irregularity2 • Coronary artery disease1,3 • Amenorrhea2 • Stroke1 • Dysmenorrhea2 • Osteoarthritis1,2• Urinary stress incontinence3 • Infertility2• Asthma/pulmonary disorder2,3• Cancer1,3 September 26, 2008 1. NHLBI 2000 (NIH), Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults 2. NIDDK 2006 (NIH), Understanding Adult Obesity. 3. Schneider BE & Mun EC. Diabetes Care. 2005; 28:475-80Texas Laparoscopic Consultants, LLP April 2009
    9. 9. You’re not alone• More than 65% of adults are overweight or obese.1• 32% of children are overweight.1• 4.8% of adults are morbidly obese.1• Total medical cost for obesity in 2003 was $75 billion.2• 325,000 obesity-related deaths occur annually.3 1. Wang, Y & Beydoun, MA. Epidemiol Rev. 2007; 29: 6-28. September 26, 2008 2. “Quick Facts: Economic and Health Burden of Chronic Disease,” CDC, updated 2007 3. Nordmann AJ et al., Arch Intern Med. 2006; 166:285-93..Texas Laparoscopic Consultants, LLP April 2009
    10. 10. DailyChallenges
    11. 11. You face obstacles and prejudices everyday September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    12. 12. High BMI can affect life expectancy• In younger & middle aged women & men, increased BMI may increase the risk of dying prematurely1• Teens entering adulthood with BMI >40 die 8-13 years earlier than the general population2 3ALL CAUSE MORTALITY RELATIVE RISK OF 2 1 <18.5 18.5 - 21.0 - 23.0 - 25.0 - 27.0 - 30.0 - >35.0 20.9 22.9 24.9 26.9 29.9 34.9 WOMEN MEN BMI September 26, 2008 1. Freedman DM et al. Int J of Obesity. 2006; 30: 822-292. 2. Fontaine KR et al. JAMA. 2003; 289: 187-93.Texas Laparoscopic Consultants, LLP April 2009
    13. 13. How much canobesityreally cost?
    14. 14. What are the costs for you? Conventional treatments Type of Diet Completing One Year 1 Weight Loss at One Year 1 Atkins® 21/40 (53%) 2.1 kg (5 lbs.) Zone 26/40 (65%) 3.2 kg (7 lbs.) Weight Watchers ® 26/40 (65%) 3.0 kg (7 lbs.) Ornish 20/40 (50%) 3.3 kg (7 lbs.) Day-to-day living Clothing, food• 1. Dansinger, et al. JAMA 2005;293(1). Atkins is a registered trademark of Atkins Nutritionals, Inc. Weight Watchers is a registered trademark of Weight Watchers International, Inc. September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    15. 15. Insurance costs go up as BMI goes upPercentage increase in costs comparing obese tonon-obese (BMI <25) Body Mass Index (kg/m 2 ) Services 30 – 34.9 ≥ 35 Physician visits +14% +25% Pharmacy +60% +78% Laboratory +24% +85% All outpatient services +21% +37% All inpatient services +33% +70% Overall +25% +44% September 26, 2008Data from a 1993 health survey of members of a large HMO (n = 17,118) Quesenberry et al. Arch Intern Med 1998;158:466Texas Laparoscopic Consultants, LLP April 2009
    16. 16. What are yoursurgical options?
    17. 17. Are you a candidate for weight-losssurgery?• BMI >35 with co-morbidities 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 our multi-disciplinary team• Understands surgery and risks Must be dedicated to a lifestyle change and lifetime follow-ups September 26, 2008 *From the NIH consensus conference in 1991Texas Laparoscopic Consultants, LLP April 2009
    18. 18. Not all weight loss surgeries are thesame1. Restrictive3. Malabsorptive5. Combination September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    19. 19. Restrictive Procedures• The size of the stomach is reduced, which limits the amount of food patients can eat.• The smaller stomach pouch fills quickly, helping patients feel satisfied with less food.• Examples of restrictive bariatric procedures: • Gastric banding • Sleeve gastrectomy September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    20. 20. Malabsorptive Procedures• The small intestine is rerouted so that food skips a portion of it.• Some calories and nutrients are not absorbed.• Currently, surgeons rarely perform strictly malabsorptive procedures.• Most procedures that involve malabsorption include restriction and are called combination procedures. September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    21. 21. Combination Procedures•The surgeon creates a small pouch, limiting the amount of food apatient can eat.•A section of the small intestine is rerouted, causing food to bypassa large portion of the small intestine.•Bypassinga portion of the small intestine means the patient’sbody absorbs fewer calories.•Examples of combination bariatric procedures: • Gastric bypass • Biliopancreatic diversion with duodenal switch September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    22. 22. Risks of abdominal surgery• Bleeding• Pain• Shoulder pain• Infection• Pneumonia• Complications due to anesthesia & medications• Deep vein thrombosis (Blood clot)• Pulmonary embolism (Blood clot in lung)• Injury to stomach, esophagus, or surrounding organs• Death September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    23. 23. Risks of bariatric surgery• Abdominal hernia • Gastrointestinal inflammation or• Chest pain swelling• Collapsed lung • Stoma obstruction• Constipation or diarrhea • Stretching of the stomach• Dehydration • Surgical procedure repeated• Enlarged heart • Vomiting and nausea• Gallstones, pain from passing a gallstone, inflammation of the gallbladder, or surgery to remove the gallbladder September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    24. 24. Adjustable gastric banding isone type of restrictive procedure• Laparoscopic or Single Incision• Second most frequently performed bariatric procedure in U.S.• Mean excess weight loss at 1 year of 50%• Requires implanted medical device• Lowest rate of complications September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    25. 25. September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    26. 26. What are risks andcomplications 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, 2008Note: 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.Texas Laparoscopic Consultants, LLP April 2009
    27. 27. What can you expect aftergastric banding?Recovery takes time and patience.• The diet is strict.• The capacity of the stomach 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 Reference: From REALIZEband.com; life with REALIZE then recovery expectations.Texas Laparoscopic Consultants, LLP April 2009
    28. 28. What can you expect aftergastric 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 Reference: From REALIZEband.com; life with REALIZE then recovery expectations.Texas Laparoscopic Consultants, LLP April 2009
    29. 29. Vertical sleeve gastrectomyis another restrictive option• Laparoscopic or Single Incision• A very good option between band and bypass.• Mean excess weight loss at 1 year of 59%2• No implanted medical device• No need for adjustments September 26, 2008 1. ASMBS, Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. June 17, 2007. 2. Lee CM, et al. Surg Endosc (2007) 21: 1810–1816Texas Laparoscopic Consultants, LLP April 2009
    30. 30. September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    31. 31. What are the risks and complicationsof a vertical sleeve gastrectomy?• Bleeding or infection• Staple line leak• Abdominal hernia• Pulmonary Embolus• Nausea and vomitting September 26, 2008Note: 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.Texas Laparoscopic Consultants, LLP April 2009G
    32. 32. A combination approach is mostcommon• Laparoscopic Roux-en-Y Gastric Bypass• Most frequently performed bariatric procedure• Mean excess weight loss at 1 year of 67%1• No implanted medical device September 26, 2008 1. Buchwald, H. et al., JAMA. 2004; 292:1724-37. 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.Texas Laparoscopic Consultants, LLP April 2009
    33. 33. September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    34. 34. What are the risks and complicationsof the Roux-en-Y procedure?• Dehiscence (separation of tissue that was stitched or stapled together)• Leaks from staple lines• Ulcers• Internal hernia• Dumping syndrome, an unpleasant side effect that may include vomiting, nausea, weakness, sweating, faintness, and diarrhea• 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 September 26, 2008Note: 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.Texas Laparoscopic Consultants, LLP April 2009
    35. 35. Duodenal Switch• Weight loss: 90% EBW• More risk of protein and vitamin deficiency• Requires maximum compliance with vitamins and protein• Some patients have more frequent stools September 26, 2008
    36. 36. Gastric Plication • Newest procedure • No removal of stomach • Not covered by insurance • Results similar to gastric sleeve September 26, 2008
    37. 37. Summary
    38. 38. Choosing the procedure that’sright for youConsiderations • Age • Health Risk (depending on comorbidities) • Amount of weight to lose • Lifestyle • Eating behaviorsMutual decision between patient and surgeon• Discuss with surgeon during initial consultation• Discuss with family and friends September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    39. 39. Surgery can help you change your life• Improves or resolves obesity-related illnesses• 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. Texas Laparoscopic Consultants, LLP April 2009
    40. 40. Resolving your co-morbid conditions•Following bariatric surgery, most patients resolve or improve their co-morbid conditions 100% 90% 86% 86% 84% 77% 79% 80% 72% 70% 62% 60% 50% 40% 30% 20% 10% 0% Diabetes Hypertension Sleep Apnea High Cholesterol* Resolved Resolved/Improved September 26, 2008 Buchwald, et al JAMA Oct 2004.Texas Laparoscopic Consultants, LLP April 2009
    41. 41. What areyour next steps?
    42. 42. You’ve already taken the first step Attend seminar (Complete!)• Obtain referral from Primary Care Physician (PCP)• Initial consultation with surgeon• Psychological evaluation• Nutritional evaluation & counseling with one of our dieticians• Verify benefits and obtain insurance authorization• Pre-operative testing• Surgery• Lifelong follow-up appointments and support groups September 26, 2008Texas Laparoscopic Consultants, LLP April 2009
    43. 43. Questions? 1200 Binz Suite # 950 Houston, Tx 77004 • When (office hours): Mon-Thurs. 8:00-5:00, Fri. 8:00-4:30 • Phone numbers: (713) 493-7700 • Fax number: (281) 971-4065 • Email: tlc@tlcsurgery.com • Web: www.tlcsurgery.comTexas Laparoscopic Consultants, LLP April 2009

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