Obesity Medicine

Your MOVE TIME Bariatric TEAM!

• Obesity Medicine Physicians

• Bariatric Surgeons

• Behavioral Medicine/Psychologists

• Dietitians

• Physical Therapists

• Nursing and Clerical staff

Goals of the MOVE TIME Clinic

• To help you lose weight, live a healthy lifestyle and improve your quality of life

– Medical management to help those not interested in surgery or not surgical candidate

– Medically optimize obesity-related comorbid conditions

– Surgical management for those interested in weight-loss surgery

Medical Evaluation: What do we do?

• Evaluate causes of obesity

• Evaluate/treat obesity-related conditions

• Offer medical treatments for obesity

– Weight loss medications

• Pre-operative evaluation

• Post-operative care

Common Causes of Obesity

• Inactivity- computer, gaming, TV time, commuting, desk work

• Excess caloric intake- large portions, liquid calories (alcohol/sodas), unhealthy food choices

Medical Causes of Obesity

• Untreated Sleep Apnea (OSA)

• Insomnia/Poor sleep

• Hormone related- Hypothyroidism, Polycystic Ovarian Syndrome, Low Testosterone, Cushings

• Depression, anxiety, PTSD, sexual trauma, stress

• Medications- e.g. psychiatric medications, insulin for diabetes

• Genetics/Epigenetics

• Traumatic Brain Injuries

Medical conditions related to Obesity

• Diabetes

• High Blood Pressure

• High Cholesterol

• Sleep Apnea

• Heart Burn/Reflux

• Joint pain/Osteoarthritis

• Fatty liver and cirrhosis

• Heart Failure

• Kidney disease

• Inflammation

• Blood Clots

• Cancers

• Infertility

• Urinary Incontinence

• Hormone Abnormalities

Treatment of Obesity

Treatment of Obesity

• Improve physical activity

• Improve diet

• Behavioral/Psychological Health

• Optimize obesity-related conditions

• Weight loss medications

• Limit medications that cause weight gain

• Weight-loss surgery (Bariatric Surgery)

Treatment of Obesity

Optimize obesity-related conditions

• Glucose control for Diabetics (goal A1c <7)

• Control blood pressure (<140/90)

• Treat high cholesterol

• Evaluate for heart disease

• Manage chronic pain

• Treat obstructive sleep apnea

Treatment of Obesity

Limit medications causing weight gain

• Psychiatric Medications

• Insulin/glipizide/glyburide

• Gabapentin

• Steroids (prednisone)

• Antihistamines (benadryl)

• Many other medications!

Treatment of Obesity

Using Weight-Loss Medications

• Requires careful evaluation and coordination with your MOVETIME Obesity Medicine provider to determine if these medications are right for you

• Can provide up to 5-10% weight loss when combined with healthy diet and exercise

Treatment of Obesity

Available Weight Loss Medications at the VA

• Orlistat (Alli or Xenical)

• Lorcaserin (Belviq)

• Phentermine

• Phentermine/Topiramate (Qsymia)

• Liraglutide (Saxenda)

• Buproprion/Naltrexone (Contrave)

• Lisdexamfetamine (for binge eating)

Bariatric (Weight Loss) Surgery

How does Bariatric Surgery work?

• Bariatric Surgery is a TOOL to promote weight loss

• Restricts the amount of food you can eat

• Causes metabolic and hormonal changes

– Improves diabetes almost immediately

– Decreases hunger and promotes fullness

Pre-Surgical Evaluation

• Age appropriate Cancer screening – Colonoscopy

– Mammogram

– Pap smear

• Endoscopy (EGD)

• Blood and Urine Tests

• Psychological Evaluation

• MOVE Participation

• Healthy Diet/Exercise

• If Indicated: – Cardiac evaluation

– Sleep apnea evaluation

– Pulmonary Function Tests

Post-Surgical Follow Up

• 1 week Telephone visit

• 2 weeks Surgery clinic visit

• 2 months MOVE TIME clinic visit

• 6 months MOVE TIME clinic visit

• 1 year visit and then yearly with MOVE TIME clinic

MOVE TIME clinic follow-up is important!

• Review laboratory testing for possible vitamin or mineral deficiencies

• Adjust medications for chronic conditions – (ie. Diabetes, High Blood Pressure, etc.)

• Recommend CPAP adjustment or sleep studies • Vitamin supplementation

– Multivitamin With Iron 200% RDA – Calcium Citrate 1200-1500mg/day – Vitamin D 1000-3000 units/day – B12 monthly injections/daily pill if Gastric Bypass – May need additional supplements

Medical Benefits of Surgery

• Diabetes- improves immediately! • High blood pressure improves • Decreases diuretic needs • Decreases cholesterol • Improves sleep apnea • Improves joint pain and mobility • Improves fatty liver • Decreases cancer risk • Decreases the risk of dying from obesity

Medical Benefits…Continued

• Improves fertility and sexual function – Men: increases testosterone

– Women: • Those of child bearing age should avoid pregnancy for

12-18 months after surgery

• Following Gastric Bypass women may need contraception other than “the pill”

• Following Gastric Bypass emergency contraception may not work

• We will discuss these changes with you

Medical Issues following Surgery

• Vitamin Deficiencies

• Low blood glucose

• Low blood pressure

• Kidney stones, gallstones

• Gout flares

• Hair loss, excess skin

• Bone thinning

• Acid Reflux

• Alcohol problems

• Mental Health Issues

• Medication Absorption changes

• Constipation

• Dumping syndrome

• Taste/Food tolerance changes

If there are difficulties after surgery then we will help you manage them!

Obesity Medicine at the Palo Alto VA

• We want to help you and we look forward toseeing you in the MOVE TIME Clinic!

• Ask your primary care provider to refer you to MOVE TIME if you are interested in beginning the evaluation for Bariatric Surgery!