Seminar web presentation
- 1. Dr. Terry Scarborough & Dr. Sherman Yu Is weight- loss surgery the answer for you?
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 5. Many factors influence obesity OBESIT Y September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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 • costly Texas Laparoscopic Consultants, LLP April 2009
- 7. How do we measure obesity? According to the National Institute of Health – Body Mass Index (BMI) is a measure of body fat based on height 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 Adults Texas Laparoscopic Consultants, LLP April 2009
- 8. Many serious illnesses are associated 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; 28:475-80 Texas Laparoscopic Consultants, LLP April 2009
- 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. Daily Challenges
- 11. You face obstacles and prejudices every day September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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 3 ALL 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. How much can obesity really cost?
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 15. Insurance costs go up as BMI goes up Percentage increase in costs comparing obese to non-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, 2008 Data from a 1993 health survey of members of a large HMO (n = 17,118) Quesenberry et al. Arch Intern Med 1998;158:466 Texas Laparoscopic Consultants, LLP April 2009
- 16. What are your surgical options?
- 17. Are you a candidate for weight-loss surgery? • 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 1991 Texas Laparoscopic Consultants, LLP April 2009
- 18. Not all weight loss surgeries are the same 1. Restrictive 3. Malabsorptive 5. Combination September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 21. Combination Procedures •The surgeon creates a small pouch, limiting the amount of food a patient can eat. •A section of the small intestine is rerouted, causing food to bypass a large portion of the small intestine. •Bypassinga portion of the small intestine means the patient’s body absorbs fewer calories. •Examples of combination bariatric procedures: • Gastric bypass • Biliopancreatic diversion with duodenal switch September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 24. Adjustable gastric banding is one 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 25. September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 26. What are risks and complications 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, 2008 Note: 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. What can you expect after gastric 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. What can you expect after gastric 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. Vertical sleeve gastrectomy is 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: 1810–1816 Texas Laparoscopic Consultants, LLP April 2009
- 30. September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 31. What are the risks and complications of a vertical sleeve gastrectomy? • Bleeding or infection • Staple line leak • Abdominal hernia • Pulmonary Embolus • Nausea and vomitting September 26, 2008 Note: 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 G
- 32. A combination approach is most common • 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. September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 34. What are the risks and complications of 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, 2008 Note: 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. 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. Gastric Plication • Newest procedure • No removal of stomach • Not covered by insurance • Results similar to gastric sleeve September 26, 2008
- 37. Summary
- 38. Choosing the procedure that’s right for you Considerations • Age • Health Risk (depending on comorbidities) • Amount of weight to lose • Lifestyle • Eating behaviors Mutual decision between patient and surgeon • Discuss with surgeon during initial consultation • Discuss with family and friends September 26, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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. 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. What are your next steps?
- 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, 2008 Texas Laparoscopic Consultants, LLP April 2009
- 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.com Texas Laparoscopic Consultants, LLP April 2009
Editor's Notes
- #5: More tell-tale image / no sleeveless
- #6: Continue to speak to the patient not being alone in this challenge
- #8: 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.
- #12: Speak to being able to do the simple things.
- #30: See adjustable gastric banding NOT CORRECT PICTURE
- #33: See adjustable gastric banding Need references
- #35: From NJ presentation
- #40: We could add a slide here showing the resolution of co-morbidities.
- #44: Fill in information pertaining to your practice.