Obesity Bariatric Surgery Our Program - Michigan Medicine · Bariatric Surgery Works National...
Transcript of Obesity Bariatric Surgery Our Program - Michigan Medicine · Bariatric Surgery Works National...
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Obesity
Bariatric Surgery
Our Program
Lets learn about:
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Facts
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Obesity is Common
Approximately 1/3 of adults in Michigan are obese.
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Obesity is Unhealthy
Obesity is related to many illnesses such as:
diabetes heart disease
high cholesterol sleep apnea
arthritis fatty liver disease
infertility certain cancers
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Losing weight helps:
Weight loss can:
Improve your health Reduce you need for prescription medication
Extend your life
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Bariatric Surgery Works
National Institutes of Health (NIH) recognizes bariatric surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term.
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Bariatric Surgery:
Gastric Bypass Sleeve Gastrectomy
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Laparoscopic Surgery
Shorter hospitalizations Quicker return to activity
Less complications
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Procedures:
Sleeve Gastrectomy
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Sleeve Gastrectomy
• General anesthesia
• 1-2 hour procedure
• 2-3 days in the hospital
• 55% - 65% excess body weight loss
• 60-100 lbs weight loss
• Maximal weight loss occurs at 1 year.
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Risks and Complications
Sleeve Gastrectomy
• Overall complications < 10%
• Major complications < 2%
• Not reversible
• Heartburn
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Procedures:
Gastric Bypass
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Gastric Bypass
• General anesthesia
• 2-3 hour procedure
• 2-3 days in the hospital
• 65% - 75% excess body weight loss
• 100-150 lbs weight loss
• Maximal weight loss occurs at 1 year.
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Risks and Complications
Gastric Bypass
• Overall complications <15%
• Major complications < 3%
• Ulcers • Highest risk with smokers and
use of NSAIDs
• Dumping syndrome
• Internal hernia
• Longer operation = higher risk of blood clots and wound complications
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Risks and Complications
Gastric Bypass
• Overall complications <15%
• Major complications < 3%
• Ulcers • Highest risk with smokers and
use of NSAIDs
• Dumping syndrome
• Internal hernia
• Longer operation = higher risk of blood clots and wound complications
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Why does surgery work?
• Limits portion size
• Decreases absorption of nutrients
• Changes body’s regulation system for gaining and losing weight
Not clear but there are lots of theories:
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When does it fail?
• Eating habits and food choices
• Physical activity
• Genetics
• Gender
• Illness
• Age
• Medications
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What happens after surgery?
• 2-3 days in the hospital
• 2 weeks - follow up in surgery clinic
• 2 months - follow up in surgery clinic
• 6 months and yearly - follow up in the Metabolic and Endocrine Clinic
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What happens after surgery?
70 grams of protein/day 64 fluid ounces/day
Small portions No concentrated sweets
No carbonated drinks
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Taking supplementalvitamins is
IMPORTANT!
Weight loss surgeryreduces vitamin
absorption.
Vitamin Supplementation
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What’s the best procedure for me?
Gastric Bypass Sleeve Gastrectomy
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Weight Loss
Complications
Balancing the risks and benefits
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Outcomes Calculator
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Outcomes Calculator
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Outcomes Calculator
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Weight Loss = Change
Weight loss is more than just a number• It’s important to match your expectations with realistic goals:
• Reduction of comorbid conditions • Reduction of prescription medications • Life-long lifestyle changes • Possible complications
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Am I a candidate?Body mass index (BMI)
BMI > 40 or
BMI > 35 +
Weight related illnesses
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Am I a candidate?Can tolerate general anesthesia.
Able to make dietary and lifestyle changes
Able to exercise
Not smoking
Psychological illnesses are well controlled
No active cancer
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The Road to Surgery
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Informational Meeting
Medical Evaluation
Dietary Evaluation
Psychological Evaluation
Review Committee Meeting (RCM)
3, 6 or 12 Months Medically
Supervised Weight Loss Documented
RCM Tasks Completed
2 Support Group
Meetings
Meet Surgeon Discuss Procedure
Pre-operative History and Exam
Insurance Authorization
Pre-Surgery Nutrition Class
Surgery
+ +
+ +
+ +
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Informational Meeting
Medical Evaluation
Dietary Evaluation
Psychological Evaluation
Review Committee Meeting (RCM)
3, 6 or 12 Months Medically
Supervised Weight Loss Documented
RCM Tasks Completed
2 Support Group
Meetings
Meet Surgeon Discuss Procedure
Pre-operative History and Exam
Insurance Authorization
Pre-Surgery Nutrition Class
Surgery
+ +
+ +
+ +
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Informational Meeting
Medical Evaluation
Dietary Evaluation
Psychological Evaluation
Review Committee Meeting (RCM)
3, 6 or 12 Months Medically
Supervised Weight Loss Documented
RCM Tasks Completed
2 Support Group
Meetings
Meet Surgeon Discuss Procedure
Pre-operative History and Exam
Insurance Authorization
Pre-Surgery Nutrition Class
Surgery
+ +
+ +
+ +
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Informational Meeting
Medical Evaluation
Dietary Evaluation
Psychological Evaluation
Review Committee Meeting (RCM)
3, 6 or 12 Months Medically
Supervised Weight Loss Documented
RCM Tasks Completed
2 Support Group
Meetings
Meet Surgeon Discuss Procedure
Pre-operative History and Exam
Insurance Authorization
Pre-Surgery Nutrition Class
Surgery
+ +
+ +
+ +
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Review Committee Letter
• Risk/Benefit Profile • Estimated weight at 1 year • Estimated complication rate
• Requirements
• Recommendations
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Informational Meeting
Medical Evaluation
Dietary Evaluation
Psychological Evaluation
Review Committee Meeting (RCM)
3, 6 or 12 Months Medically
Supervised Weight Loss Documented
RCM Tasks Completed
2 Support Group
Meetings
Meet Surgeon Discuss Procedure
Pre-operative History and Exam
Insurance Authorization
Pre-Surgery Nutrition Class
Surgery
+ +
+ +
+ +
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Insurance
• Coverage Varies: • Private Insurance • Veterans • Medicare
• You need to contact your provider for specific details
• Use our insurance questionnaire as a guide
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Important questions for your insurance carrier:
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Medically Supervised Weight Loss Documentation
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Multidisciplinary Team
Surgeons Endocrinologists
Physician Assistants Psychologists
Dietitians Certified Bariatric Nurse
Patient Service Associates
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On-line Resources
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C-Tools
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Weight-Loss Conditioning Program
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Hunger Within
• Nationally recognized treatment for weight management
• 12 week program
• Explores core reasons for overeating (triggers for emotional eating)
https://www.uofmhealth.org/hunger-within-workshop
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Clinic
Domino’s FarmsLobby A, Suite 1200 4008 Ave Maria Dr. Ann Arbor, MI 48105
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Surgery
University of MichiganHealth System
1500 E. Medical Center Dr Ann Arbor, MI 48109
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Next Steps
1. Provide your name and contact information.
2. Contact your insurance carrier about details of your policy