Understanding the BioEnterics LAPBAND System

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Presented by oBand Surgery Centers, Inc.
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What We Will Cover Today

• What is obesity?
• Why weight-loss surgery?
• Pros and cons of surgical options for obesity
• The LAP-BAND System
• Insurance and patient financing
• Why oBand Surgery Centers, Inc.?
• Questions and answers
• Next steps

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Before We Start

• At the end of the seminar, please complete
  seminar evaluation form
• Feel free to ask questions as we go along
• You can sign up for an office consultation with
  our surgeons by talking with our Patient
  Coordinator after the seminar

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oBand Surgery Centers, Inc.

• oBand Surgery Centers, Inc is a leading bariatric
  network of outpatient surgical facilities.
• Our board certified bariatric surgeons are among
  the few American specialists experienced in the
  state of the art adjustable and reversible
  gastric banding procedure. oBand expert surgeons
  have successfully performed thousands of
  bariatric procedures.  
• Our facilities are physician designed to provide
  a uniquely comprehensive environment focused on
  the safest, most effective minimally invasive
  surgical treatment and care of obesity.

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What Is Obesity?

• Obesity is a chronic disease
• People who are obese have too much body fat
• Excess body fat often results in health problems

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What Causes Obesity?

• Being obese is the result of a combination of
  influences
• The genes you inherited from your parents
• How well your body turns food into energy
• Your eating and exercising habits
• Your surroundings
• Psychological factors

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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

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Where Do You Fit In?

• 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)
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1985 Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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1990 Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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1995 Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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2000 Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
No Data lt10 10-14
15-19 ?20
Source BRFSS, CDC.
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Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
1991
1995
2000
Source BRFSS, CDC.
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2001 Obesity Trends Among U.S. Adults
(BMI ? 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
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Consequences of Obesity

• If you are obese, severely obese, or morbidly
  obese, you may have
• Major health risks
• Risks to psychological and social well-being
• Difficulties with day-to-day living

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Health Risks Body Mass Index vs. Mortality
Exponential Increase in Risk
Source NIH, NEJM, 1995.
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Health Risks (cont)

• Severe and morbid obesity greatly increases the
  risk of dozens of serious medical problems

• Diabetes
• Hypertension
• Sleep apnea
• Heart disease
• Vascular disease/Stroke
• Immobility
• Skin infections

• Cancer
• Gallstones
• Urinary incontinence
• GERD
• Arthritis
• Venous ulcers
• Accident proneness

• Depression
• Joint problems
• Low back pain
• Infertility
• DVT and thromboembolism
• Asthma, etc, etc.

Source The Surgeon Generals Call to Action to
Prevent Overweight and Obesity.
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Risks to Your Psychologicaland Social Well-Being

• Negative self-image
• Social isolation
• Discrimination

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Difficulties With Day-to-Day Living

• Normal tasks become harder when you are obese
• Movement is more difficult
• You tend to tire more quickly
• You find yourself short of breath
• Bus or airplane seats, telephone booths,
  turnstiles, and cars may be too small for you
• You may find it difficult to maintain personal
  hygiene

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Obesity Treatment Options

• Non-surgical methods result in little long-term
  success
• Diet and exercise
• Weight-loss programs
• Appetite suppressants
• Hypnosis, jaw-wiring, counseling
• Doing nothing is really not an option

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Using Surgery to Treat Obesity

• Surgery is an option when other weight-loss
  therapies have failed
• Types of weight-loss surgeries
• Malabsorptive procedures shorten the digestive
  tract
• Restrictive procedures reduce how much the
  stomach can hold
• Combined procedures shorten the digestive tract
  and reduce how much the stomach can hold

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Using Surgery to Treat Obesity (cont)
Restrictive and Adjustable
Malabsorptive
Combined
Restrictive
Gastric Bypass (GBP)
LAP-BAND System
Vertical Banded Gastroplasty (VBG)
Bilio-Pancreatic Diversion (BPD)
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Open vs. Laparoscopic Surgery

• Open
• Large incision
• Longer hospital stay
• Surgeon handles the organs

• Laparoscopic
• Small incisions
• Less pain, shorter hospital stay
• Surgeon uses thin, specialized instruments

LAP-BAND surgery is usually performed
laparoscopically
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Gastric Bypass

• Advantages
• Rapid initial weight loss
• Disadvantages
• Stomach cutting, stapling and intestinal
  re-routing required
• More operative complications than LAP-BAND
• Portion of digestive tract is bypassed, resulting
  in nutritional deficiencies
• Dumping syndrome can occur
• Non-adjustable
• Extremely difficult to reverse
• Higher mortality rate than LAP-BAND

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The LAP-BAND System

• Advantages
• Lowest mortality rate
• Least invasive surgical approach
• No stapling, cutting, or intestinal re-routing
• Adjustable
• Reversible
• Lowest operative complication rate
• No Dumping Syndrome
• Low malnutrition risk since no portion of
  digestive tract is bypassed
• Disadvantages
• Regular follow-up critical for optimal results
• Rarely, the access port may leak and require
  minor revisional surgery

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Your Decision

• LAP-BAND System
• Least invasive
• No re-arrangement of anatomy
• 59 average long-term excess weight loss,
  slower initially
• Lowest mortality (10 times safer) and
  complication rate
• Adjustable
• Reversible
• Low malnutrition risk
• Shorter hospital stay and recovery time
• Follow-up necessary

• Gastric Bypass
• More invasive
• Anatomy re-arranged
• 60 average long-term excess weight loss,
  faster initially
• Higher mortality and complication rate
• Non-adjustable
• Difficult to reverse
• High malnutrition risk
• Longer hospital stay and recovery time
• Follow-up not required

Sources OBrien et al. LAP-BAND Outcomes and
Results ASERNIPS 2002
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Comparing Weight-Loss Results
Source OBrien et al. Obesity is a Surgical
Disease Overview of Obesity and Bariatric
Surgery, ANZ J Surg, 2004 74 200-204.
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How the LAP-BAND System Works

• A silicone band is placed around the upper part
  of the stomach
• A small pouch is created
• Your stomach holds less food
• You feel full faster and longer

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The LAP-BAND System Procedure
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The LAP-BAND System Is Adjustable

• The plastic band is hollow
• It is filled with a saline solution
• By adding or removing the saline, your surgeon
  can tighten or loosen your band
• This allows control over individual weight loss

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Medical Insurance Criteria for LAP-BAND System
Candidates includes the following

• Meet the BMI criteria
• Your BMI is at least 40, or
• You weigh at least 100 pounds more than your
  ideal weight, or
• Your BMI is at least 35 and you are suffering
  from serious health problems
• In some cases, you may be eligible for surgery if
  your BMI is between 30 and 35
• Have been overweight for more than 5 years
• Have had only short-term success with serious
  weight-loss attempts
• Do not have any other disease that could have
  caused obesity
• Are prepared to attend regular follow-up sessions
  and make lifestyle changes
• Do not drink alcohol in excess

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Self Pay Criteria forLAP-BAND System Candidates
includes the following

• Are prepared to attend regular follow-up sessions
  and make lifestyle changes
• Do not drink alcohol in excess
• Consultation with surgeon to evaluate individual
  needs and goals

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Possible Risks and Complications

• Risks associated with any surgery
• Slippage
• Erosion
• Access port problems

For detailed risk information, please visit
www.lap-band.com
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LAP-BAND Weight-Loss Results
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LAP-BAND System PatientRobin (Before)

• Heres what my life was like. Pick up three
  50-pound bags of dog food strap them to your
  body. Then try walking.
• It was difficult to even bend down to pick up my
  little girl.

310 pounds
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LAP-BAND System PatientRobin (After)

• Now, I have the energy to play with my children
  and am comforted to know Ill be around when they
  grow up.

161 pounds
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Living with the LAP-BAND System

• LAP-BAND will help you feel satisfied with a
  small amount of food
• You will enjoy meals and eating out with family
  and friendsjust in smaller portions
• Your motivation and commitment is key to your
  success!
• Learn to eat few small, nutritious meals
• Begin an exercise program
• Schedule regular check-ups
• Get your band adjusted from time to time to
  optimize your individual weight loss
• Regularly attend support group meetings
• Use your LAP-BAND as a tool to help you lose
  weight

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A Word on Adjustments

• Following surgery, LAP-BAND is usually partially
  inflated
• First adjustment is typically not until 4-6 weeks
  after surgery
• Adjustments depend on
• Your weight loss
• Amount of food you can comfortably eat
• Amount of fluid already in your band

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Weight Loss Can Change Your Life

• Improved or resolved health problems
• Reduced health risks
• Increased energy and activity level
• Improved self-esteem

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LAP-BAND Affordability

• Pursue insurance coverage
• Review the coverage in your insurance policy
• Understand the appeal process and probability of
  coverage
• Speak with our office
• Direct pay alternative
• Lump sum payment (401(k) fund, savings, stocks,
  etc.)
• Loans (equity) and credit cards (low rate or
  cash back)
• oBand Surgery Centers, Inc. work with several
  finance companies to help make your dream come
  true.

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The LAP-BAND System Finance Program

• Free expert advice
• Low monthly payments
• Competitive interest rates
• Lenders are large, stable, well-funded companies
• Focused on financing the LAP-BAND procedure only
• Diverse financing options (secured and unsecured)
• Higher loan approval ratio
• Quick decision
• Preliminary decision within 1-2 days
• Funding in 5-15 business days

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Potential Savings

• Thousands of dollars in potential tax savings
• According to the new Internal Revenue service
  (IRS) policy (Revenue Ruling 2002-19), obesity
  is medically accepted to be a disease in its own
  right
• A taxpayer can now claim weight loss expenses as
  a medical deduction
• Savings of 2,000 to 4,000 are common
• Changes in monthly expenses
• Change in the cost of living before and after
  weight-loss surgery can be dramatic

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The Personal Cost of Obesity
References 1. Health Management Research Center,
University of Michigan, 2001 2. U.S. Bureau of
Labor Statistics, Consumer Expenditures in 2001
3. Source Colditz, GA. Economic costs of
obesity and inactivity, Med Science Sports
Exercise, 1999 4. Marketdata Enterprises, Inc.,
10/02 5. U.S. Bureau of Labor Statistics,
Consumer Expenditures in 2001
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Mission Statement

• To promote, encourage and enhance outpatient
  bariatric surgical care, research and education
  for the benefit of all patients

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Why oBand Surgery Centers, Inc.?

• Only exceptional surgeons with superior outcomes
  perform surgery at oBand Surgery Centers, Inc.
• Thousands of successful bariatric procedures
  performed
• Comprehensive program including cardiology,
  plastics, gynecology, internal medicine,
  anesthesiology to meet the needs of patients.
• Have surgery in the morning and go home in the
  afternoon.
• Less risk of infection than in a hospital setting
• Caring and compassionate staff
• JCAHO certified and AAAHC certified
• Owned and operated by nationally recognized Lap
  Band surgeons

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oBand Surgery Centers, Inc.

• oBand Surgery Centers, Inc. is THE standard of
  care for outpatient Lap Band Surgery.
• oBand Surgery Centers, Inc. not only has industry
  credentials such as JCAHO and AAAHC, but has
  established criteria above and beyond these
  certifying bodies to make patient care and safety
  at the forefront of everything we do.

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Next Steps

• Question Answers
• Please fill out seminar evaluation forms
• If you would like to schedule a consultation to
  see if the LAP-BAND System is appropriate for
  you
• Speak with our Patient Coordinator after the QA
  or
• Contact oBand Surgery Centers, Inc. directly at
• 866-883-BAND or 866-886-BAND

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Lose Weight and Feel Great with