10/29/2011. Metabolic, Obstetric, and Gynecological Consequences of Bariatric Surgery. Case Presentation: Rachelle. Jonathan Carter, MD
|
|
- Claud Weaver
- 5 years ago
- Views:
Transcription
1 Metabolic, Obstetric, and Gynecological Consequences of Bariatric Surgery 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity lbs BMI 44.5 PMHx: mild depression obstructive sleep apnea (AHI 42, on CPAP) asthma polycystic ovarian syndrome gastroesophageal reflux disease Diet attempts: Weight Watchers Atkins HerbaLife South Beach Jonathan Carter, MD No disclosures Case Presentation: Rachelle Case Presentation: Rachelle Intervention: LRYGB Weight versus time weight (pounds) time (months) PMHx: mild depression RESOLVED obstructive sleep apnea (AHI 42, on CPAP) RESOLVED asthma RESOLVED polycystic ovarian syndrome NO MEDS gastroesophageal reflux disease RESOLVED 1
2 Case Presentation: Rachelle BRFSS, 1990 No Data <10% 10% 14% BRFSS, 1991 BRFSS, 1992 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% 2
3 BRFSS, 1993 BRFSS, 1994 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% BRFSS, 1995 BRFSS, 1996 No Data <10% 10% 14% 15% 19% No Data <10% 10% 14% 15% 19% 3
4 BRFSS, 1997 BRFSS, 1998 No Data <10% 10% 14% 15% 19% 20% No Data <10% 10% 14% 15% 19% 20% BRFSS, 1999 BRFSS, 2000 No Data <10% 10% 14% 15% 19% 20% No Data <10% 10% 14% 15% 19% 20% 4
5 BRFSS, 2001 BRFSS, 2002 No Data <10% 10% 14% 15% 19% 20% 24% 25% No Data <10% 10% 14% 15% 19% 20% 24% 25% BRFSS, 2003 BRFSS, 2004 No Data <10% 10% 14% 15% 19% 20% 24% 25% No Data <10% 10% 14% 15% 19% 20% 24% 25% 5
6 BRFSS, 2005 BRFSS, 2006 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% BRFSS, 2007 BRFSS, 2008 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 6
7 Why is obesity bad? Obesity reduces life expectancy For young men, BMI >45 took off 13 years of life expectancy For young women, BMI >45 took off 8 years of life expectancy Mechanick et al. SOARD 2008 Randomly assigned 811 patients to 4 groups: low fat, low protein high fat, high protein low fat, high protein high fat, low protein Intensive group/individual instructional sessions Intensive follow-up to 2 years Katan, NEJM
8 Medicines for the treatment of obesity Robert H. Eckel, MD INDICATIONS FOR BARIATRIC SURGERY Gastric bypass anatomy Definition BMI Normal < 25 Overweight Obese, class Obese, class Obese, class Superobese 60+ with co-morbidity SURGERY 8
9 LapBand anatomy (a.k.a. gastric banding) Sleeve gastrectomy Annals of Surgery,
10 Metabolic benefits of bariatric surgery courtesy of ASMBS After gastric bypass, DM2 commonly resolves within days or weeks, before any significant weight loss has occurred. After gastric bypass, 83% of diabetics and 97% of patients with impaired glucose tolerance will normalize their fasting blood glucose, HbA1c, and insulin levels. The effect is durable, at least for 15 years. Metabolic benefits of bariatric surgery blood glucose insulin courtesy of ASMBS 10
11 fasting blood glucose diabetic <5 years diabetic 6-10 years diabetic >10 years impaired fasting glucose diet controlled diabetics oral agent diabetics insulin dependent diabetics HbA1C (%) diabetic <5 years diabetic 6-10 years diabetic >10 years impaired fasting glucose diet controlled diabetics oral agent diabetics insulin dependent diabetics WHY DOES DIABETES RESOLVE? By direct calorie restriction / weight-loss: % using medication for diabetes control oral agent diabetics insulin dependent diabetics fat mass adiponectin insulin sensitivity caloric intake insulin requirement = beta cell rest Specific to gastric bypass (and not LapBand or other restrictive procedures) ghrelin adiponectin, blocks hepatic insulin signaling, glucagon nutrients to ileum GLP-1 insulin, glucagon, insulin sensitivity beta-cell mass, beta-cell apoptosis nutrients to ileum peptide YY caloric intake nutrients to duodenum??? insulin sensitivity 11
12 systolic BP 50% of the morbidly obese have HTN Bariatric surgery and comorbidity resolution About 40% of those on antihypertensives will be able to wean off medications completely. About 50% of undiagnosed hypertensives will resolve completely. diastolic BP BMI courtesy of ASMBS About 70% of morbidly obese patients have sleep apnea. Bariatric surgery About 90% will come off CPAP completely and comorbidity resolution Apnea-hypopnea index oxygen saturation sleepiness courtesy of ASMBS 12
13 Bariatric surgery and comorbidity resolution 1 year after RYGB 2 years after RYGB RYGB dropped percentage of dyslipidemic patients from 95% to 28% Number taking medication dropped to 15% courtesy of ASMBS CANCER INCIDENCE Lancet July, 2009 Retrospective cohort study after gastric bypass Bariatric surgery reduces risk of: colon cancer endometrial cancer breast cancer prostate cancer ovarian cancer obese controls surgery 7,925 gastric bypasses in Utah 7,925 age, sex, BMI matched compared rates of death and cause using National Death Index 40% reduction in mortality: 56% reduction from CAD 92% reduction from DM 60% reduction from cancer native obese population 58% increase in non-disease deaths 13
14 Prospective, controlled trial 2010 patients underwent bariatric surgery 2037 matched patients underwent conventional Rx Mean 11 years of follow-up 99% of patients were followed Decrease mortality was from decrease in incidence of myocardial infarction and cancer Safety: Early Complications Bypass Band Safety: Late Complications 14
15 Bypass stricture of gastrojejunostomy (2-3%) treatment: dilation during endoscopy Band acute pouch outlet obstruction (0-10%) treatment: nasogastric tube marginal ulceration (3-5%) treatment: antacids gallstone disease (2% with prevention) prevention: ursodiol for 6 months treatment: remove gallbladder internal hernias with obstruction (0-5%) treatment: surgery dumping syndrome (0-10%) treatment: limit simple sugars, high protein diet, complex carbs, high fiber, smaller more frequent meals band erosion (0-7%) treatment: surgery to remove band gallstone disease (2% with prevention) prevention: ursodiol for 6 months treatment: remove gallbladder port infection (0.3-9%) treatment: surgery to remove port band slippage (2-14%) treatment: surgery to remove/reposition band port or tubing malfunction (0.4-7%) treatment: surgery to fix malfunction acid reflux or esophageal dilation (0-10%) treatment: antacids or band removal psychological intolerance (0-5%) treatment: removal of band LATE REOPERATION (5-10%) LATE REOPERATION (12-20%) Outcome Effect Sources Fertility anovulatory infertility (odds ratio 2-3) Miscarriage success with in-vitro fertilization no clear effect Thrombosis rate of PE, DVT (odds ratio 2) Gestational Diabetes Pregnancyinduced hypertension with odds ratio 2-5 with odds ratio 2 (CI ) Preeclampsia with odds ratio 2.7 (CI ) Green 1988, Grodstein 1994, Metwally 2007 Linstein 2005, Fedorcsak Wan 2002, Lashen 2004, Weiss 2004 Abdollahi 2003 Sebire 2001, Kumari 2001 Sattar 2001 Sattar 2001 Outcome Effect Sources Postpartum risk of hemorrhage risk of genital tract infection risk of wound complications Stillborns risk by factor of Preterm delivery Neural tube defects Obesity and Pregnancy no clear effect with odds ratio 1.8 (CI ) Omphalocele with odds ratio 3.3 (CI ) Sebire 2001 Nohr 2005 Spinillo 1998 Waller 1994 Watkins 2003 Labor 50% increase in fetal distress, C-section rate is 2x Bianco 1998 Weiss 2004 Macrosomia with odds ratio 2.1 (CI ) (independent effect of diabetes) Battacharya
16 Outcome Effect Sources Fertility menstrual regularity in 3 of 4 women with restoration of ovulation PCOS symptoms (less hirsuitism, blood testosterone, DHEA) overall fertility Pregnancy preeclampsia, eclampsia (OR 0.2) Perinatal outcomes Effects of bariatric surgery hypertension (OR 0.39) gestational diabetes (OR 0.6) no good data Birth Weight macrosomia 7.6% to 3.2% Nelson 2007 Escobar 2005 Maggard 2008 Bilenka 1995 Bennett 2010 Wittgrove 1998 Weintraub 2008 Premature birth or miscarriage increased, RR 1.30 McDonald 2010 Neonatal Outcomes after Bariatric Surgery Nutritional Outcomes for Pregnancy after Bariatric Surgery 16
17 Nutrition for pregnancy after bariatric surgery Before pregnancy While pregnant 2 prenatal MVIs daily 2 prenatal MVIs daily omeprazole 20mg daily calcium + D 500mg 3x daily Iron sulfate 325mg + vitamin C 500mg daily vitamin B12 500mcg daily omeprazole 20mg daily calcium + D 500mg 3x daily Iron sulfate 325mg + vitamin C 500mg daily vitamin B12 500mcg daily Weight gain goal: lbs, mostly in 3 rd trimester. Protein shakes if needed. No specific imaging needed Labs: yearly folate, iron, B12, LFTs, albumin, Ca, glu Labs: monthly folate, iron, B12, Ca, albumin, prealbumin (may be overkill) 17
6/23/2011. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle
Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive
More information10/28/11. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle
Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive
More information11/11/2011. Bariatric Surgery for Sleep Apnea. Case Presentation: Rachelle. Case Presentation: Rachelle. Case Presentation: Rachelle
Bariatric Surgery for Sleep Apnea 2,000 B.C. 2,000 A.D. 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive sleep apnea (AHI 42, on CPAP) asthma polycystic ovarian
More informationWhat s New in Bariatric Surgery?
Bariatric Surgery: Update for the General Surgeon What s New in Bariatric Surgery? 2,000 B.C. 2,000 A.D. 1. America keeps getting fatter without an end in sight. 2. Bariatric surgery is not just about
More informationDisclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery
Obesity and Its Challenges: Bariatric Surgery: Why or Why Not I have nothing to disclose Disclosures Lan Vu, MD Division of Pediatric Surgery Department of Surgery Outline Growing obesity epidemic Not
More informationMorbid Obesity A Curable Disease?
Morbid Obesity A Curable Disease? Piotr Gorecki, M.D. F.A.C.S. Associate Professor of Clinical Surgery Weill Medical College of Cornell University Chief of Laparoscopic Surgery New York Methodist Hospital
More informationBariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018
Bariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018 Disclosures None Objectives Review expected weight loss from
More informationSURGICAL MANAGEMENT OF OBESITY. Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery
SURGICAL MANAGEMENT OF OBESITY Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery Multi-Factorial Causes of Morbid Obesity include: Genetic Environmental
More informationTechnique. Matthew Bettendorf, MD Essentia Health Duluth Clinic. Laparoscopic approach One 12mm port, Four 5mm ports
Matthew Bettendorf, MD Essentia Health Duluth Clinic Technique Laparoscopic approach One 12mm port, Four 5mm ports Single staple line with no anastamosis 85% gastrectomy Goal to remove
More informationViriato Fiallo, MD Ursula McMillian, MD
Viriato Fiallo, MD Ursula McMillian, MD Objectives Define obesity and effects on society and healthcare Define bariatric surgery Discuss recent medical management versus surgery research Evaluate different
More informationADVANCE AT YOUR OWN PACE
ADVANCE AT YOUR OWN PACE Welcome and Introductions Obesity and Its Impact on Health Surgeon Introduction Surgical Weight Loss Options AGENDA OSVALDO ANEZ, MD 28 years of experience Performed approximately
More informationWeight Loss Surgery. Outline 3/30/12. What Every GI Nurse Needs to Know. Define Morbid Obesity & its Medical Consequences. Treatments for Obesity
3/30/12 Weight Loss Surgery What Every GI Nurse Needs to Know Kenneth A Cooper, D.O. March 31, 2012 Outline Define Morbid Obesity & its Medical Consequences Treatments for Obesity Bariatric (Weight-loss)
More information10/16/2014. Normal Weight: BMI Overweight: BMI >25 Obese: BMI >30 Morbidly Obese: BMI >40 or >35 with 2 comorbidities
Brinton Clark, MD, MPH Department of Medical Education Providence Portland Medical Center October 25 th, 2014 Oregon Society of Physician Assistants Fall Conference 45 yo woman with BMI=40kg/m2 (weight
More informationLecture Goals. Body Mass Index. Obesity Definitions. Bariatric Surgery What the PCP Needs to Know 11/17/2009. Indications for bariatric Surgeries
Bariatric Surgery What the PCP Needs to Know Mouna Abouamara Assistant Professor Internal Medicine James H Quillen College Of Medicine Lecture Goals Indications for bariatric Surgeries Different types
More informationBariatric Surgery: Indications and Ethical Concerns
Bariatric Surgery: Indications and Ethical Concerns Ramzi Alami, M.D. F.A.C.S Assistant Professor of Surgery American University of Beirut Medical Center Beirut, Lebanon Nothing to Disclose Determined
More informationNot over when the surgery is done: surgical complications of obesity
Not over when the surgery is done: surgical complications of obesity Gianluca Bonanomi, MD, FRCS Consultant Surgeon and Honorary Senior Lecturer Chelsea and Westminster Hospital London The Society for
More informationWEIGHT LOSS SURGERY A Primer on Current Options and Outcomes. Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018
WEIGHT LOSS SURGERY A Primer on Current Options and Outcomes Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018 A Little Bit About Me Bariatric Surgical Services Reflux Surgery General Surgery Overview
More informationBariatric Surgery: A Cost-effective Treatment of Obesity?
Bariatric Surgery: A Cost-effective Treatment of Obesity? Shaneeta M. Johnson MD FACS FASMBS 2018 NMA Professional Development Seminar Congressional Black Caucus Foundation Annual Legislative Conference
More informationThe New GDM Screening Guidelines. Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program
The New GDM Screening Guidelines Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program Disclosures Current participant (RCH site) for MiTy study Metformin in women
More informationSurgical Therapy for Morbid Obesity. Janeen Jordan, PGY 5 Surgical Grand Rounds April 7, 2008
Surgical Therapy for Morbid Obesity Janeen Jordan, PGY 5 Surgical Grand Rounds April 7, 28 Obesity BMI > 3 kg/m 2 Moderate 35-4 kg/m 2 Morbid >4 kg/m 2 1.7 BILLION Overweight Adults in the world 63 MILLION
More informationThe Surgical Management of Obesity
The Surgical Management of Obesity Omar al noubani MD,MRCS وك ل وا و اش ز ب وا و ال ت س رف وا األعراف ما مأل ابن آدم وعاء شر ا من بطنه Persons who are naturally fat are apt to die earlier than those who
More informationManipal & Apollo Spectra Hospital. Special Interest:Laparoscopy & Bariatric Surgery
Name: Dr M G Bhat Designation: Consultant Surgeon Affiliation: Manipal & Apollo Spectra Hospital Special Interest:Laparoscopy & Bariatric Surgery When should we suggest Bariatric Surgery in PCOD? 17 June
More informationOBESITY MANAGEMENT: DIET/EXERCISE, NEW DRUGS AND/OR SURGERY?
OBESITY MANAGEMENT: DIET/EXERCISE, NEW DRUGS AND/OR SURGERY? ERIC VOLCKMANN, MD DIRECTOR OF BARIATRIC SURGERY OCTOBER 20, 2017 OBJECTIVES Define prevalence and health effects of obesity Discuss different
More informationA Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications
A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications Shahzeer Karmali MD FRCSC FACS Associate Professor Surgery University of Alberta
More informationIs laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass?
Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry Sandhya B. Kumar MD, Barbara C. Hamilton MD, Soren Jonzzon,
More informationBariatric Surgery. Options & Outcomes
Bariatric Surgery Options & Outcomes Obesity Obesity now leading cause of premature death & illness in Australia 67% of Australians are overweight or obese Australia 4 th fattest nation in OECD Obesity
More informationDisclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None
Disclosures None OBESITY Florencia Halperin, M.D. Medical Director, Program for Management Brigham and Women s Hospital Instructor in Medicine, Harvard Medical School Overview Obesity: Definition Definition
More informationComplications of Pregnancy and Lifetime Risk to Health. Brian McCulloch MD Advocate Lutheran General Hospital September 26, 2015
Complications of Pregnancy and Lifetime Risk to Health Brian McCulloch MD Advocate Lutheran General Hospital September 26, 2015 Pregnancy as a window to future health In 2005 the CDC stated that almost
More informationManagement of Pregestational and Gestational Diabetes Mellitus
Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is
More informationBariatric Surgery MM /11/2001. HMO; PPO; QUEST 05/01/2012 Section: Surgery Place(s) of Service: Outpatient; Inpatient
Bariatric Surgery Policy Number: Original Effective Date: MM.06.003 09/11/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 05/01/2012 Section: Surgery Place(s) of Service: Outpatient;
More informationFRESH START. Time For A BARIATRIC SURGERY! WHAT IS BARIATRIC SURGERY? UHS Medical Times EVERYTHING YOU NEED TO KNOW ABOUT علاج ال دانة وجراحة السمنة
UHS Medical Times 1 Newsletter September 2018 علاج ال دانة وجراحة السمنة MINIMALLY INVASIVE Time For A FRESH START EVERYTHING YOU NEED TO KNOW ABOUT BARIATRIC SURGERY! While any surgical procedure carries
More informationChairman s Rounds, 02/15/2011
Chairman s Rounds, 02/15/2011 Edward Lipkin, MD Associate Professor, Department of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington Predictive factors in patient s
More information2/13/2018. Update on Gestational Diabetes. Disclosure. Objectives. I have no financial conflicts of interest.
Update on Gestational Diabetes Lorie M. Harper, MD, MSCI Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine 2/18/2018 Disclosure I have no financial conflicts of interest. Objectives
More informationEffect of Bariatric Surgery on Cardio-Metabolic Outcomes
Effect of Bariatric Surgery on Cardio-Metabolic Outcomes Disclosure Research support from Bariatric Advantage (supplements donated for research study) Anne Schafer, MD Associate Professor of Medicine and
More informationBariatric Surgery Work Up, Patient Selection and Follow Up
Bariatric Surgery Work Up, Patient Selection and Follow Up A/Professor Tania Markovic Metabolism & Obesity Services, RPAH Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders SLHD Bariatric
More informationBariatric Surgery. Overview of Procedural Options
Bariatric Surgery Overview of Procedural Options The Obesity Epidemic In 1991, NO state had an obesity rate above 20% 1 As of 2010, more than two-thirds of states (38) now have adult obesity rates above
More informationOctober 2004 TrueNorth Health Newsletter Page 1
October 2004 TrueNorth Health Newsletter www.healthpromoting.com Page 1 Volume 2 Issue 2 In This Issue TrueNorth Health Chiropractors Add New Technique (page 1) Do You Need to Fast? (page 1) Are You Too
More informationAdipocytes, Obesity, Bariatric Surgery and its Complications
Adipocytes, Obesity, Bariatric Surgery and its Complications Daniel C. Morris, MD, FACEP, FAHA Senior Staff Physician Department of Emergency Medicine Objectives Basic science of adipocyte Adipocyte tissue
More informationBariatric Surgery: The Primary Care Approach
The 8 th Annual Conference of the Lebanese Society of Family Medicine October 25 th 2009 Bariatric Surgery: The Primary Care Approach Bassem Y. Safadi, MD, FACS Associate Professor of Clinical Surgery
More informationPolycystic Ovarian Syndrome. Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology
Polycystic Ovarian Syndrome Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology Outline Definition Symptoms Causal factors Diagnosis Complications Treatment Why are we talking about
More informationDISCLOSURES. Laparoscopic Adjustable Gastric Banding (LAGB) As An Option For Failed Gastric Bypass Procedure In Obese Patients
Laparoscopic Adjustable Gastric Banding (LAGB) As An Option For Failed Gastric Bypass Procedure In Obese Patients Presented By: Ali Hazrati, Md, Msc, FRCSC Co-authors: Patrick Yau, MD, Jamie Cyriac, MD
More informationLong-Term Follow Up: The Burning Platform
Long-Term Follow Up: The Burning Platform John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and
More informationRemoval of a lap band and revision to an alternative bariatric procedure in one procedure.
How to Discuss the Case with Insurance Plan Medical Director, Letter of Medical Necessity, and Increasing the Chance of Letters of Medical Necessity are a well-known requirement when requesting authorization
More informationObesity and Bariatric Surgery Michel M. Murr, MD, FACS
Obesity and Bariatric Surgery Michel M. Murr, MD, FACS Director of Bariatric Center Chief of Surgery, TGH Professor of Surgery, USF Disclosure Covidien: educational grants Obesity and Bariatric Surgery
More informationJAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial
JAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial Daniel DeUgarte, MD Division of Pediatric Surgery Surgical Director, UCLA FIT Program Bariatric
More informationBARIATRIC SURGERY. Weight Loss Surgery. A variety of surgical procedures to reduce weight performed on people who have obesity. Therapy Male & Female
BARIATRIC SURGERY Weight Loss Surgery A variety of surgical procedures to reduce weight performed on people who have obesity. Therapy Male & Female About Bariatric surgery Bariatric surgery offers a treatment
More informationCertified Bariatric Nurse Review Course. Session 1
Certified Bariatric Nurse Review Course Session 1 Session 1 Review of CBN certification Introduction to Morbid Obesity History of weight loss surgery Objectives The purpose of this program is to inform
More informationOverview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco
GASTROINTESTINAL COMPLICATIONS AFTER BARIATRIC SURGERY Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco UCSF DEPARTMENT OF SURGERY Original Article
More informationBariatric Surgery: Reproductive Implications
Disclosures Bariatric Surgery: Reproductive Implications I have no significant financial disclosures Lauren A. Miller MD MPH February 22, 2018 O bjectives State of the obesity problem Prevalence of Self-Reported
More informationSession 6B Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success
Session 6B Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success Part 2 John Dawson, FSA, MAAA Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success SOA Asia-Pacific
More informationThe Impact of Insulin Resistance on Long-Term Health in PCOS
Saturday, April 16 th, 2016 PCOS Challenge & Thomas Jefferson University PCOS Awareness Symposium Philadelphia The Impact of Insulin Resistance on Long-Term Health in PCOS Katherine Sherif, MD Professor
More informationBenefits of Bariatric Surgery
Benefits of Bariatric Surgery Dr Tan Bo Chuan Registrar, Department of Surgery GP Forum 27 May 2017 Improvements of Co-morbidities Type 2 diabetes mellitus Hypertension Hyperlipidemia Degenerative joint
More informationCase Presentation: Morbidly Obese Adolescent. Daniel DeUgarte,, MD Division of Pediatric Surgery Surgical Director, UCLA FIT Program
Case Presentation: Morbidly Obese Adolescent Daniel DeUgarte,, MD Division of Pediatric Surgery Surgical Director, UCLA FIT Program R.A. 15y/o Adolescent Girl 138kg / 160.8cm 53.4 BMI Overweight since
More informationGoals 1/9/2018. Obesity over the last decade Surgery has become a safer management strategy Surgical options for management
The Current State of Surgical Intervention in Management of Morbid Obesity Goals Obesity over the last decade Surgery has become a safer management strategy Surgical options for management 1 Goals Obesity
More informationObesity and Weight Loss Surgery for the Primary Care Physician
Saturday General Session Obesity and Weight Loss Surgery for the Primary Care Physician Nicole Basa, MD Bariatric and General Surgeon Cedar Park Surgeons, PA Cedar Park, Texas Educational Objectives By
More informationAmerican College of Physicians October 21, 2017 Oklahoma Chapter Scientific Meeting. Bariatric Surgery
American College of Physicians October 21, 2017 Oklahoma Chapter Scientific Meeting Bariatric Surgery Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines
More informationBariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS
Bariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS Nothing to Disclose Types of Bariatric Surgery Restrictive Malabsorptive Combination Restrictive and Malabsorptive Newer Endoluminal
More informationOBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN
OBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN Nicole Basa, M.D., F.A.C.S., F.A.S.M.B.S Assistant Professor of Surgery Texas A&M Medical School Bariatric Medical Director- Cedar Park Regional
More informationPolicy Specific Section: April 14, 1970 June 28, 2013
Medical Policy Bariatric Surgery Type: Medical Necessity and Investigational / Experimental Policy Specific Section: Surgery Original Policy Date: Effective Date: April 14, 1970 June 28, 2013 Definitions
More informationFamily Doctors Association July 2015 Weight Loss Surgery
Family Doctors Association July 2015 Weight Loss Surgery Consultant Surgeon Salford Royal Hospital Introduction Definition BMI = weight (kg) height (m) 2 Classification: BMI (kg/m2) Description
More informationIndex. B Balloon dilations, 140, 144 Bariatric emergencies cardiac complications, cardiovascular system, 42 gastric band placement, 42
A Acceptance and Commitment Therapy (ACT), 157 158 Acceptance-Based Behavioral Treatment (ABBT), 157 Adjustable gastric bands (AGB), 8, 115 Air-leak test, 80 American Association of Clinical Endocrinologist
More informationGestational Diabetes: Long Term Metabolic Consequences. Outline 5/27/2014
Gestational Diabetes: Long Term Metabolic Consequences Gladys (Sandy) Ramos, MD Associate Clinical Professor Maternal Fetal Medicine Outline Population rates of obesity and T2DM Obesity and metabolic syndrome
More informationSurgical Weight Loss Educational Manual
Surgical Weight Loss Educational Manual Highest Level of Accreditation Since 2005 Northern Light Surgical Weight Loss Lynn Bolduc, MS, RD, CDE Manager, Northern Light Surgical Weight Loss 207 973 4940
More informationBariatric Surgery Outcomes
Bariatric Surgery Outcomes Kristoffel R. Dumon, MD a, Kenric M. Murayama, MD b, * KEYWORDS Bariatric surgery Outcomes Obesity Obesity is a global health problem and the exponential increase in obesity
More informationRoux-and-Y Gastric Bypass and its Metabolic Effects
Roux-and-Y Gastric Bypass and its Metabolic Effects Nicola Di Lorenzo President elect of SICOb Italian Society for Bariatric Surgery and Metabolic Diseases Dept. of General Surgery-Università di Roma Tor
More informationMorbid Obesity The Surgical Approach. Jonathan A. Schoen, M.D. Assistant Professor of Surgery University of Colorado Health Sciences Center
Morbid Obesity The Surgical Approach Jonathan A. Schoen, M.D. Assistant Professor of Surgery University of Colorado Health Sciences Center Today s s Lineup Definition Population Statistics Childhood Obesity
More informationMetabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology
Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient
More informationWeight Loss Surgery Program
Weight Loss Surgery Program More than 500,000 Americans die prematurely each year from obesity-related complications, and it is one of the leading causes of preventable death. If you want to do something
More informationJohn C. Mobley, MD Pounds Off Pulaski Jan. 12, 2015
John C. Mobley, MD Pounds Off Pulaski Jan. 12, 2015 Why are we here To help Pulaski County get inspired to get the Pounds Off! John C. Mobley, MD, FACS Bariatric surgeon Laurel County native University
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationENTRY CRITERIA: C. Approved Comorbidities: Diabetes
KAISER PERMANENTE OHIO BARIATRIC SURGERY (GASTROPLASTY) Methodology: Expert Opinion Issue Date: 12-05 Champion: Surgery Review Date: 4-10, 4-12 Key Stakeholders: Surgery, IM Depts. Next Update: 4-14 RELEVANCE:
More informationOptimizing Postpartum Maternal Health to Prevent Chronic Diseases
Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research
More informationGestational Diabetes. Gestational Diabetes:
Gestational Diabetes Detection and Management Steven Gabbe, MD The Ohio State University Medical Center Gestational Diabetes: Detection and Management Learning Objectives: At the conclusion of this presentation,
More information12/12/14. Primary Care of the Bariatric Surgery Patient. Goals
Primary Care of the Bariatric Surgery Patient Goals Michelle Guy, MD Associate Professor Division of General Internal Medicine University of California, san Francisco How many post- bariatric surgery pa8ents
More information2018 Standard of Medical Care Diabetes and Pregnancy
2018 Standard of Medical Care Diabetes and Pregnancy 2018 Standard of Medical Care Diabetes and Pregnancy Marjorie Cypress does not have any relevant financial relationships with any commercial interests
More informationAbout PCOS. About PCOS
About PCOS About PCOS Polycystic Ovarian Syndrome (PCOS) is the most common hormonal reproductive problem in women of childbearing age. It can affect a woman s menstrual cycle, fertility, hormones, insulin
More informationLaparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease
Laparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease Erik Peltz, D.O. April 7 th, 2008 University of Colorado Health Science Center Department
More informationTable Classification of body mass index (BMI) and risk of comorbidities in adults (WHO, 1998; WHO Expert Consultation,
Table 7.13.1 Classification of body mass index (BMI) and risk of comorbidities in adults (WHO, 1998; WHO Expert Consultation, 2004) Classification BMI (kg/m 2 ) BMI (kg/ m 2 ) Asian origin Risk of comorbidities
More informationPregnancies complicated by diabetes. Marina Mickleson Nurse Practitioner Midwife CDE
Pregnancies complicated by diabetes Marina Mickleson Nurse Practitioner Midwife CDE Two types Pre gestational Gestational diabetes Both types are on the increase Pre conception work up is imperative for
More informationPractical recommendations for the post-bariatric surgery medical management
Practical recommendations for the post-bariatric surgery medical management Dr L. Favre CHUV Sce Endocrinologie, diabétologie et métabolisme 26.04.2018 Bariatric surgery in Switzerland Multidisciplinary
More informationBariatrics: : The Next Five Years
Bariatrics: : The Next Five Years Kent C. Sasse, M.D., MPH, F.A.C.S, Medical Director Western Bariatric Institute Founder, International Metabolic Institute Reno, NV A Revolution In The Making Author:
More informationI want to be a good example for my daughters.
I want to be a good example for my daughters. I chose weight loss surgery because I want to be healthy. I was very overweight, often short of breath and experienced hip and knee pain from carrying around
More informationWhat's Obesity all about?
Disclaimer This movie is an educational resource only and should not be used to make a decision on Obesity management. All decisions about obesity management should be made in conjunction with your doctor
More informationUpdate on Bariatric Surgery. Learning Objectives: At the end of this lecture you should be able to: Currently Available Options
Update on Bariatric Surgery Dan Bessesen, MD Chief of Endocrinology; Denver Health Medical Center Professor of Medicine, University of Colorado School of Medicine Daniel.Bessesen@ucdenver.edu Learning
More informationCurrent Trends in Diagnosis and Management of Gestational Diabetes
Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives
More informationJordan Garrison Jr. MD, FACS, FASMBS
Jordan Garrison Jr. MD, FACS, FASMBS A life-long progressive, lifethreatening, geneticallyrelated, costly, multifactorial disease of excess fat storage with multiple comorbidities ~ 25% industrialized
More informationRevision For Weight Regain
Revision For Weight Regain When? Why? What? Ahmad Aly ANZMOSS Dietetics Workshop 2018 Reoperative Surgery What Is Reoperative? Reversal Correction Conversion } Revisional Surgery Revisional Surgery 4000
More informationEpidemics of Obesity in the United States
Epidemics of Obesity in the United States Obesity: A Modern Epidemic It has recently become obvious that the prevalence of obesity has been rapidly increasing in the United States Obesity is definitely
More informationBariatric Surgery and Post Operative Patient Care Alisha M. Fuller DNP, CBN, FNP BC Tristate Bariatrics Clinical Director, NP Manager
Bariatric Surgery and Post Operative Patient Care Alisha M. Fuller DNP, CBN, FNP BC Tristate Bariatrics Clinical Director, NP Manager Presentation Objectives Causes of Obesity Measuring Obesity Medical/Psychological/Social
More informationCURRENT STRATEGIES IN MANAGEMENT OF OBESITY. Prevalence of Obesity (Adults)
CURRENT STRATEGIES IN MANAGEMENT OF OBESITY Robert B. Baron MD MS Professor of Medicine Associate Dean for GME and CME Director, UCSF Weight Management Program Declaration of full disclosure: No conflict
More informationGastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor
Gastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2007 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution
More informationNutritional Considerations with Obesity and Bariatric Surgery. Presented by Dr. Ron Grabowski
Nutritional Considerations with Obesity and Bariatric Surgery Presented by Dr. Ron Grabowski January 25, 2010 Nutritional Considerations with Obesity and Bariatric Surgery Presented by Dr. Ron Grabowski
More informationAccess to Proven Therapies
Access to Proven Therapies Obesity is a life-threatening disease affecting 34% of adults in the U.S. Between 2000 and 2005, obesity increased by 24%, morbid obesity by 50%, and super obesity by 75%. 18%
More informationOBESITY:Pharmacotherapy Vs Surgery
OBESITY:Pharmacotherapy Vs Surgery Dr. Ranajit Sen Chowdhury Associate Professor Department of Medicine Sir Salimullah Medical College & Mitford Hospital. 1 Historical Perspective Paleolithic Era > 25,000
More informationtype 2 diabetes is a surgical disease
M. Lannoo, MD, University Hospitals Leuven Walter Pories claimed in 1992 type 2 diabetes is a surgical disease Buchwald et al. conducted a large meta-analysis THE FIRST OBSERVATIONS W. Pories 500 patients
More information3 Things To Know About Obesity Surgery
3 Things To Know About Obesity Surgery Dr Jon Armstrong 1st Edition Introduction... 3 1. Am I A Candidate?... 4 2. What Are The Options?... 5 3. How Does It Work?... 6 Conclusion... 9 Follow me here...
More informationACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute
ACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute Disclosures Authors: No disclosures ACS-NSQIP Disclaimer: The American College
More informationMANAGEMENT OF OBESITY: A
MANAGEMENT OF OBESITY: A Systematic Approach In the United States (over the last decade) the overall prevalence of obesity is: Robert B. Baron MD MS Professor of Medicine Associate Dean for GME and CME
More informationIs mini bypass as mini as we think it is? Nutritional consequences
Is mini bypass as mini as we think it is? Nutritional consequences Mini/ single loop bypass What is a mini bypass? Single loop One anastomosis Mini Prevalence Increasing Who is the single loop bypass for?
More informationBariatric Surgery. The Oregon Bariatric Center Surgical Team
Bariatric Surgery The Oregon Bariatric Center Surgical Team Colin MacColl, MD, Medical Director, Bariatric Surgeon Jessica Folek, MD, Bariatric Surgeon I have no disclosures Disclosures Objectives What
More information