Nutritional Trends and Implications for Weight Loss Surgery

Transcription

1 Nutritional Trends and Implications for Weight Loss Surgery This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers and

2 MFLN Intro Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities 2 Sign up for webinar notifications at

3 Today s Presenter Ashley McCartney, MS, RD, LDN Received her Masters of Science in Family and Consumer Sciences with a focus in nutrition from Eastern Illinois University. Currently practicing as a registered licensed Bariatric / Clinical Dietitian at Carle Physician Group. Professional interests focus on weight management for adults and pediatrics, as well as general nutrition education for the community, including support groups to promote healthy lifestyles. 3

4 By: Ashley R. McCartney, MS, RD, LDN Carle Physician Group Urbana, IL 4

5 Describe and understand types of bariatric surgeries Identify current practice guidelines for MNT in bariatrics Identify key factors in pre-op assessments for long-term success 5

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7 Estimate costs range from $147 billion to $210 billion / year. Associated with job absenteeism Lower productivity while at work Obese adults spend 42 percent more on direct healthcare costs than adults who are a healthy weight. In the U.S., second leading cause of death after tobacco 7

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9 Classification of Obesity Classification BMI Risk of Comorbidities Underweight <18.5 Low Normal Average Overweight Increased Obese Class I Moderate Obese Class II Severe Obese Class III Super Obese >/= 50.0 Very severe Photo taken from WHO 9

10 Most effective treatment for severe obesity Resolution of co-morbid conditions Impact on medication regimen Impact on metabolic and hormonal changes Fad / crash / yo-yo dieting does not work Quick fix? Photos taken from and 10

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12 Have any of you worked or are currently working with someone who has had weight loss surgery? What issues or successes have you encountered with this population? Which surgery have you seen or found to be most successful in your patient population? 12

13 Types of Bariatric Surgeries 13

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15 Restrictive Procedure First introduced in 1978 by Wilkinson 1986 current procedure done across the world FDA approved in 2001 How does the adjustable band function? Rate of weight loss Outpatient procedure 15

16 Diabetes 50% Dyslipidemia 50% Hypertension 60% Sleep apnea 90% 16

17 Band slippage Leakage of tubing / balloon Port or band infection Obstruction Nausea / vomiting Band erosion into stomach Esophageal dilatation Failure to lose weight 17

18 Diet progression Portion sizes Vitamin regimen Physical activity regimen 18

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20 Unfilled Band Filled Band Photo taken from 20

21 Vertical Sleeve Gastrectomy Photo taken fromwww.darylsmarxmd.com 21

22 Restrictive Procedure Irreversible Popularized in early 2000s Still under research for efficacy How does the sleeve function? Rate of weight loss Inpatient hospital stay 22

23 Diabetes 80% Dyslipidemia 60% Hypertension 60% Sleep apnea 95% 23

24 Leaks 1-2% Strictures <1% 24

25 Diet progression Portion sizes Vitamin regimen Physical activity regimen 25

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27 Mouth Proximal gastric pouch Jejunum Bile duct Pancreas Descending duodenum Food absorbed Photo taken from To rest of bowel 27

28 Malabsorptive procedure Reversible Developed in the 1960s How it functions Rate of weight loss Why is bypass considered the gold standard? Inpatient hospital stay 28

29 Diabetes 90% Dyslipidemia 70% Hypertension 65% Sleep apnea 90% Reflux 98% 29

30 Diet progression Portion sizes Vitamin regimen Physical activity regimen 30

31 For those of you that have worked with weight loss surgery patients, what surgery have you found to be the most successful? What are the most common complaints you hear from this population after surgery? How would you predict a successful outcome in a patient seeking weight loss surgery? 31

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33 Preoperative weight loss prior to surgery Lap band rate of weight loss Sleeve gastrectomy rate of weight loss Gastric bypass rate of weight loss 33

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36 No deaths 10% SAE s 19% had balloon removed early Nausea, vomiting, abdominal pain, reflux in hrs. 36

37 BMI In conjunction with long term diet/behavior modification program Failed more conservative teatments Maximum duration of placement 6 mos. 37

38 Reasonable option for temporary weight loss Very skeptical about long term weight loss efficacy High potential for inappropriate use Most beneficial indications are currently offlabel 38

39 Biliopancreatic diversion Biliopancreatic diversion with duodenal switch Silastic ring gastric bypass Endoscopic sleeve gastroplasty Vbloc AspireAssist 39

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41 Carle Foundation Hospital: Expected Outcomes References First Trimester Close collaborative efforts between the bariatric surgeon and obstetrician. Patient must notify office as soon as pregnancy is confirmed and appointment made for fluid removal. All fluid will be removed to minimize restriction of band. Maintain healthy fetal development. Minimize risks associated with obesity, pregnancy and poor neonatal outcomes through weight management. Fluid removal will allow for optimal nutritional intake during embryogenesis and minimize risk for hyperemesis during the first trimester. Dixon, J. B., Dixon, M. E., & O'Brien, P. E. (2001). Pregnancy after lap-band surgery: Management of the band to achieve healthy weight outcomes. Obesity Surgery, (11), Second Trimester A band fill will be performed no earlier than 14 weeks gestation or later if weight gain is excessive. Based on IOM weight gain recommendations, the band fills will be performed to minimize excessive weight gain (not to promote weight loss). Recommendations for weight gain are based on varying BMI levels and are to be determined by obstetrician. Management of band will be based on weight gain recommendations. Third Trimester All fluid will be removed from the band at 36 weeks gestation. Reduce impact of band on delivery. Post-Partum A band fill will not be performed until lactation is established. Band adjustment will likely be close to prepregnancy levels. Initiate weight loss or weight maintenance. 41

42 Timing of pregnancy Recommended lab work Protein requirements Weight gain 42

43 Surgery for pregnancy Sports nutrition- i.e. marathons, etc. Surgery for other medical procedures Photos from:

44 "The State of Obesity: Obesity Data Trends and Policy Analysis." The State of Obesity: Obesity Data Trends and Policy Analysis. N.p., n.d. Web. 1 Apr Allison DB, Fontaine KR, Manson JE, Stevens, J, Vanitallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16) Cawley J and Meyerhoefer C. The Medical Care Costs of Obesity: An Instrumental Variables Approach. Journal of Health Economics, 31(1): , 2012; And Finkelstein, Trogdon, Cohen, et al. Annual Medical Spending Attributable to Obesity. Health Affairs, Cawley J, Rizzo JA, Haas K. Occupation-specific Absenteeism Costs Associated with Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49(12):1317?24, Gates D, Succop P, Brehm B, et al. Obesity and presenteeism: The impact of body mass index on workplace productivity. J Occ Envir Med, 50(1):39-45, Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable to Obesity: Payerand Service-Specific Estimates. Health Affairs, 28(5): w , Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric Surgery. A systematic review and meta-analysis. JAMA Oria, HE. Gastric banding for morbid obesity. Eur J Gastroenterol Hepatol 1999;11: Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12: Saber AA, Elgamel MH, McLeod, MK. Bariatric surgery: the past, present and future. Obesity Surgery Including Laparoscopy and Allied Care, 2008;18(1):121-8 Weight Control Information Network, National Institutes of Health. Bariatric surgery as a treatment for obesity. National Institute of Diabetes and Digestive and Kidney Diseases. 2011, June. Accessed August 30, 2012 from Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12: Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1): [Research Support, Non- U.S. Gov t Review.] Dixon, J. B., Dixon, M. E., & O'Brien, P. E. (2001). Pregnancy after lap band surgery: Management of the band to achieve healthy weight outcomes. Obesity Surgery, (11),

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50 50 This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers and