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Weight Loss Surgery


Weight Loss Surgery at East Carolina University An Introduction to Our Program: Before, During, and After! * The LAP-BAND System is the safest and least invasive ... – PowerPoint PPT presentation

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Title: Weight Loss Surgery

  • Weight Loss Surgery
  • at
  • East Carolina University
  • An Introduction to Our ProgramBefore, During,
    and After!

Goals and Objectives
  • Describe obesity and health effects of obesity
  • Describe weight loss programs offered by East
    Carolina University (ECU)
  • Describe pre-operative work-up and post-operative
    care related to weight loss surgery

Our Informational Materials
  • This is not intended to persuade you to have
    surgery and should NOT be considered medical
  • Only you, your family, your medical doctor, and
    your surgeon know if bariatric surgery is right
    for you
  • If you are interested in exploring weight loss
    surgical options further, you will need to talk
    with a bariatric surgeon

Why have your surgery with ECU?
  • Our surgeons are highly qualified experts
  • We are involved in research
  • We have an array of services aimed at providing
    care to morbidly obese clients and their families
  • We genuinely want to help you reach your goals

Choosing a Surgeon
  • You or your doctor may choose a specific surgeon
    from our practice to see.
  • The surgeon that you select may require
    additional personal or medical information in
    order to schedule an appointment.
  • Once you have established a relationship with our
    surgeons, you should then follow only their
    advice and educational materials

  • What is Morbid Obesity?
  • Being 100 pounds over ideal weight
  • (your ideal body weight will be calculated
    during your first visit with your surgeon)
  • Using the Body Mass Index (BMI)
  • Morbid Obesity is defined as a person
  • -BMI of 40 or higher
  • OR
  • -BMI of 35 or higher with co-morbidities
    related to
  • morbid obesity

Sizing Up Your Level of Body Fat
  • Using the Body Mass Index (BMI)
  • Used to determine if you
    qualify for surgery
  • Measures obesity based on weight
    and height

Changing Perceptions of the Seriously Overweight
  • In the Past
  • Obesity was seen as a weakness or failure of
  • Diet and exercise were prescribed treatments
  • Weight loss surgery was viewed as dangerous and
  • Now in the Present
  • Obesity is considered a disease and the cause of
    many serious health conditions
  • Surgery has gained acceptance as the only proven
    method to treat this disease

What are the impacts of Obesity??
  • Social Implications
  • Unfortunately, still an acceptable form of social
  • Economic Implications
  • Personal cost 15,568 per year (diets, food,
  • National cost 200 billion
  • 93 billion in medical bills
  • 33 billion on weight-loss products/services
  • Medical and Health Implications
  • With BMI gt 30
  • 70 increase in coronary artery disease
  • 75 increase in stroke
  • 400 increase in diabetes
  • 55 increase in mortality

  • Health Conditions Associated with
  • Morbid Obesity (Co-morbidities)
  • High Blood Pressure Heart Disease
  • Congestive Heart Failure Swelling (legs, feet)
  • Diabetes Sleep Apnea
  • Degenerative Joint Disease DVT (Blood Clots)
  • Shortness of Breath Acid Reflux
  • Stress Incontinence Depression
  • Irregular Menstrual Cycles
  • Gallbladder Disease

What are your options??
  • 1. Diets, exercise, and behavioral change
  • Up to 10 loss of excess body weight
  • Ineffective long-term less than 5 sustain any
    significant weight loss
  • 2. Weight Loss Drugs
  • Minimal sustained weight loss
  • Side effects prevent long term use
  • 3. Weight Loss Surgery
  • Average 55-75 loss of excess body weight

Source Adkinson, Am J. Clinical Nutrition, 1994
Who Qualifies for Weight-Loss Surgery?
  • Clinical Terms Used to Describe Various Levels of
    Body Fat

Normal Weight (BMI 18.5 to 24.9)
Overweight(BMI 25 to 29.9)
Obese(BMI 30 to 34.9)
Severely Obese(BMI 35 to 39.9 )
Morbidly Obese(BMI 40 or more)
BMI 25-29.9
BMI 30-34.9
BMI 35-39.9
BMI 18.5-24.9
Characteristics of Potential Candidates
  • 100 pounds above your Ideal Body Weight
  • Body Mass Index
  • -40 or greater with no co-morbidities
  • -35 or greater with co-morbidities
  • Age of 18 to 65 (assessed on individual basis)
  • Failed attempts at weight loss
  • Health complications related to obesity
  • No psychological contraindications
  • Understanding of the surgery/risks
  • Compliance with diet/exercise requirements

Most Common Surgical Options
Roux-en-Y Bypass
Restrictive and malabsorptive
Gastric Bypass
  • Advantages
  • Rapid initial weight loss
  • Laparoscopic approach is possible
  • Longer experience in USA
  • Takes 1-2 hours
  • Disadvantages
  • Stomach cutting, stapling and intestinal
    re-routing required
  • Portion of digestive tract is bypassed, resulting
    in nutritional deficiencies
  • Dumping syndrome can occur
  • Non-adjustable
  • Extremely difficult to reverse

  • Dumping Syndrome
  • -Stomach contents move too rapidly through the
    small intestines following surgery
  • Does not happen with the band.
  • Avoid by following prescribed diet
  • -Symptoms
  • -Rapid heart beat -Headache
  • -Sweating -Nausea
  • -Dizziness -Diarrhea
  • -Lightheadedness -Stomach cramping
  • -Sleepiness

The LAP-BAND System
  • Advantages
  • Lowest mortality and complication rate
  • Least invasive surgical approach
  • No stapling, cutting, or intestinal
  • Adjustable
  • Reversible
  • Low malnutrition risk
  • Takes 1 hour/ outpatient surgery
  • Disadvantages
  • Slower initial weight loss than Gastric Bypass
  • Regular follow-up critical for optimal results
    Need adjustments
  • Requires implanted medical device

What Surgery is Right for Me?
  • All surgery has risks
  • Not all patients are candidates for surgery
  • Discuss your options with your surgeon

Possible Risks and Complications
  • Remember there are risks associated with any
  • Your surgeon will discuss specific details
    regarding each surgical option at your first new
    patient appointment.

Comparing Weight-Loss Results
Gastric Bypass
Source OBrien et al. Obesity is a Surgical
Disease Overview of Obesity and Bariatric
Surgery, ANZ J Surg, 2004 74 200-204.
  • Your Appointments With the Surgeon and the
    Surgery Practice
  • You will have three visits with your surgeon
    before your surgery.
  • Your first visit is called your New Patient
    Visit. At this visit, you will do the following
  • - Talk with the surgeon about the procedure
  • - Explore financial and insurance
  • - Have a brief physical exam
  • - Determine preoperative evaluations
    you may need
  • - We will remind you to STOP SMOKING!!!
    You must be
  • smoke-free for 3 months prior to
    surgery and should not
  • smoke after surgery as well!
  • - Have an opportunity to complete a few
    tests before going
  • home.

After the New Patient Visit
  • You will receive a letter a few weeks later with
    appointments you must keep before your second
    visit. These will include
  • Psychological evaluation
  • Nutrition evaluation
  • Upper Gastric Exam
  • Blood testing (lab work)
  • Anesthesia Consult
  • Also, if not done at your new patient visit
  • Chest X-Ray
  • EKG
  • ABG

  • Possible Pre-Operative Evaluations
  • (you may need these additional tests before your
    second visit
  • if your surgeon feels it is necessary)
  • Other Lab Work
  • Colonoscopy
  • Sleep Study
  • Upper gastric endoscopy
  • Consult with cardiologist
  • Consult with pulmonologist
  • Consult with vascular doctor
  • Ultrasound of the abdomen

6 Month Program
  • Depending on your insurance company, you may
    have to complete a six month diet and exercise
    program. Please refer to the example progress
    note in your introductory handout. When you
    contact our office, we will inform you if this is
    your insurance requirement. If you do require a
    program, you will need to complete 4 months prior
    to being scheduled for your first visit with the

Scheduling your appointments
  • Please do not miss your appointments!!
  • Remember rescheduling may mean prolonging your
  • If you repeatedly miss an appointment or fail to
    show up for an appointment without notice, you
    may be dismissed from the program. This surgery
    is a lifestyle change, and we want you to be
    successful in your weight loss journey!

  • Making The Decision
  • Once your consults and tests are completed, you
    will have your second visit, called the Decision
  • -You will be seen in the clinic by your surgeon
  • -Tests results are reviewed
  • -All questions about the surgery are answered
  • -The risks and benefits of the surgery are
    reviewed with you
  • -Research opportunities will be discussed with
  • -You will receive a prescription for a diet that
    we will instruct you to begin 2-3 weeks before

Prescription Diet Before Surgery
  • We will give you the prescription for Optifast,
    which will be in the form of shakes (and the
    choice of one soup if you like) in place of
  • This prescription is not usually covered by
    insurance. It is approximately 71 per week.
  • This diet will allow you to jumpstart your weight
    loss journey.
  • At your first appointment, we will go into
    further detail regarding your pre-operative diet.

  • Insurance Approval Process
  • After your Decision Visit, our office will
    begin the approval process if you are an adequate
    candidate for surgery.
  • We will mail or fax your evaluations, diet and
    exercise history, letters of clearance, and
    personal letter from our office to your specific
    insurance company.
  • This approval process may take as long as 6-8

  • Insurance Coverage Approved
  • When we receive insurance approval, we will
    contact you with your third appointment and
    surgery date!
  • Your third appointment is the History and

History and Physical Appointment
  • Includes the following
  • Brief physical exam
  • Discussion of surgery, risks and benefits
  • Consent forms signed
  • Update lab work and tests if necessary
  • Must have support person present or your surgery
    may be cancelled!!

  • Insurance Tips to Remember
  • You MUST meet the requirements of all the
    insurances that you have prior to submitting for
  • Depending on your insurance company, the approval
    process may be lengthy (6-8 weeks)
  • You must check your SPECIFIC policy (or policies)
    to make sure weight loss surgery is a covered
  • If your insurance company denies your request for
    surgery, the appeal process may be started. This
    can be quite lengthy and involved, so it is
    important to know from the beginning your
    specific insurance companys criteria. We will
    help you to the best of our ability to meet these
    requirements, but it is ultimately your
    responsibility to be familiar with your
    individual insurance policy.

Helpful Hints Prior to Surgery
  • This is a weight-loss program! Any weight gain
    could result in prolonging, rescheduling, or
    cancelling your surgery.
  • You must quit smoking! We may require a nicotine
    test prior to having surgery in order to ensure
    you have stopped.
  • Multiple cancellations, skipped appointments, or
    just not showing up for appointments can result
    in prolonging the pre-operative process and
    possibly dismissal from the program.

  • Day of Surgery
  • (you have been approved and completed your third
    visit which is your History Physical)
  • -You will be admitted to our Ambulatory Surgery
    Unit (ASU)
  • -An IV will be started
  • -You will be given an antibiotic and additional
    teaching by the nurse
  • -After you have been prepared for surgery, you
    will go to the operating holding area
  • -Your family may wait in the family waiting area
  • and will be contacted after the operation

  • Recovery
  • Hospital Stay Open surgery (3 to 4 days)
  • Laparoscopic (2 to 3 days) Lap
    Band (1-2days)
  • Out of Work Open surgery (4 to 6 weeks)
  • Laparoscopic (2 to 4 weeks)
  • Lap Band (1 to 2 weeks)
  • -No driving for 1-2 weeks following surgery
  • -No heavy lifting anything over 10 pounds for one
    month after surgery

  • Gastric Obesity Procedure (GOP)
  • Diet Following Surgery
  • GOP Level I Diet
  • - This starts after surgery and lasts
    for 2 weeks
  • -Two ounces (1/4 of a cup) of Optisource in
  • place of meals
  • -Between meals you may have two ounces
  • of non-sweetened, non-carbonated
    beverages. - You MUST SIP WATER all day long
  • -No carbonated beverages

  • Home Diet Following Surgery
  • We will give you specific details about your
    diet following weight loss surgery. Generally
    this consist of
  • Drastically limiting volume
  • Limiting the consistency of food
  • Limiting the types of food

  • Tips for Eating After
  • Weight Loss Surgery
  • -Do not drink liquids with meals, either drink 30
    minutes before or 30 minutes after
  • -Chew food well
  • -Take small bites of food
  • -Eat meals over a 30 to 45 minute time span
  • -Eat meals on small plate, use baby spoon

Eating after LAP BAND
  • Small volumes 2-3 oz. of healthy foods
  • Similar restrictions as the gastric bypass
  • When you are not filling up than adjustment
    needs to be done.
  • Band may need to be adjusted 3-4 times in first
  • Diet modified after each adjustment

  • How Much Weight Can a Patient Expect to
    Lose Following Surgery?
  • Depends on the surgery and the follow-up
  • 75 of excess weight -with Gastric bypass at the
    end of one year
  • 45 of excess weight with Band but increases to
    65 at 2-3 year follow up with adjustments
  • Amount of weight loss varies from person to
  • Must be compliant with follow-up!!!!!

  • Plastic Surgery Consult Following Surgery
  • -There may be excess skin on the chest, abdomen
    and arms and legs
  • -We can refer you to a plastic surgeon when the
    following criteria is met
  • -After you Have Maintained a Stable Weight
    (this may be 12-18 months or longer)
  • - Your nutritional status is adequate
  • - Your surgeon will ultimately decide when
    this referral is appropriate
  • -Insurance rarely covers these procedures.
    Document issues with your primary care now and
    after surgery.

Vitamins and Medications after Surgery(REQUIRED
for LIFE)
  • Gastric Bypass
  • -2 chewable multivitamins daily (ex Flinstones)
  • -Calcium Citrate or Tums
  • 1000 mg daily
  • -Vitamin D 800 iu daily
  • -Vitamin B 12 250 mcg daily
  • -Ferrous Sulfate elixir 325 mg daily
    (menstruating women only)
  • Band
  • -2 chewable multivitamins daily (ex Flinstones)
  • In addition, women take
  • -Calcium Citrate or Tums
  • 1000 mg daily
  • -Vitamin D 800 iu daily

Vitamins and Medications Tips to Remember!
  • After surgery, all vitamins and medications need
    to be one of the following
  • - Please speak with your primary care doctor and
    pharmacist to help adjust these medications. Some
    drugs are NOT safe to crush.

Pregnancy following Surgery
  • -Females should not become pregnant for at least
    12 to 18 months following Gastric Bypass.
    Pregnancy prior to this could result in fetal
    demise or neural tube defects
  • - After the band surgery, it is best you maintain
    a stable weight loss and plateau prior to
    becoming pregnant.
  • - You must follow what your surgeon tells you is
    best, and please inform them if you plan on
    having children in the future after weight loss

  • Follow-Up After Surgery
  • Gastric Bypass
  • Lifelong commitment
  • Every 2 weeks for first month after surgery
  • Every 3 months for the first year after surgery
  • Yearly for a lifetime
  • Lab work is checked at every visit
  • Lap Band
  • Life long commitment
  • 2 weeks and 6 weeks after surgery
  • At 6 weeks, you may have your first adjustment
  • Monthly for first year
  • After first year, surgeon will decide how often
    to see you
  • Lab work checked every 3 months

  • Support Groups
  • We encourage you to join a support group prior to
    surgery and maintain participation with the
    support group after surgery.
  • Ideally, you should attend the support group
    offered by your surgical practice.
  • Our Support Group is the 3rd Tuesday of each
    month at 6pm. Enter through the Brody Outpatient
    Center Lobby and follow the signs!

  • Exercise
  • - Exercise is an important part of your weight
    loss journey. Remember, surgery is a tool to help
    you reach your goals. You must do your part as
  • - You will work up to doing exercise daily for 30
    to 45 minutes per day
  • - Exercise options can include
  • -Walking with hand weights
  • -Bike riding -Weight Training
  • -Aerobics -Jogging
  • -Swimming
  • -Water aerobics

Making An Appointment
  • The next step in pursuing weight loss surgery is
    a visit with a qualified bariatric surgeon.
  • If you already have an appointment with a weight
    loss surgeon, please keep the appointment, or if
    you are no longer interested, please contact
    their office to cancel your appointment.

  • Thank you for reviewing our informational
    material! We look forward to working with you in
    the future, and we are available to answer any
    questions you may have.
  • Please type in the following web address in your
    internet browser to receive your certificate,
  • http//www.ecu.edu/weightlosssurgery/certificate.c
  • Please print out the following certificate and
    sign. This certificate is proof that you have
    completed our online orientation. Please write
    down any questions you may have on the space
    provided. You must bring this form with you to
    your first appointment with the surgeon, as this
    is a requirement for our program. We look forward
    to seeing you soon!
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