Bariatric Surgery Center Centegra Health System Huntley IL

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1 Bariatric Surgery Center Centegra Health System Huntley IL

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3 We Honor and Value Your Individuality! Here for Different Reasons Tried Everything Better Health Reduce or Eliminate Medications Become More Active Less Pain Doctor or Friend Recommended Knowledge is at a different level Congratulations this is the first step! are you Unsure? or Ready? For all of these reasons W e l c o m e Hopeful Tired of Feeling Frustrated? Motivated Excited! Nervous

4 Goal of Info Session Describe the program Explain the importance of a multidisciplinary team Nutrition Phases Your Responsibility if you join our team Introduce Practitioners Overview of the causes of obesity Overview of the risks of obesity Bariatric Surgical Procedures Bariatric Surgery Misconceptions Our goal is that you gain knowledge and have all your questions answered and that you all feel empowered to take the next steps to better health

5 Binder Overview 1. Contact Phone List 2. Health Questionnaire 3. Patient Care Pathway 7. Sleep Center 8. Health Bridge 9. Support Group 4. Program Guidelines 10. Education Syllabus 5. Diet Phases 6. Behavioral Health 11. BMI Table 12. Presentation Evaluation

6 Centegra Weight Loss Surgery Center Program Launched 2002 Led by Director of the Program Dr. Amir Heydari and includes a multidisciplinary team consisting of Bariatric trained: Anesthesiologists, Psychologists, Nurses, Dietitians, Exercise Physiologists, Financial and Administrative Staff, Surgical Technicians and many more. Center of Excellence 2009 Centegra Bariatric Surgery Program was awarded a Bariatric Surgery Center of Excellence in August Huntley 2017 In 2017 Centegra moves Bariatric Surgery to Huntley, creating an integrated location for: The Bariatric Center, Surgery, Info Session and Support Group.

7 Bariatric Surgery means weight loss surgery Bariatric surgery has been shown to be the most effective treatment for the disease of Obesity. Centegra Weight Loss Surgery Center combines excellence in both clinical and surgical skill, with ongoing support and follow-up care. The Bariatric Center is made up of a multidisciplinary team of caring professionals to assist you in the journey to better health.

8 Multifaceted Multidiscipline Most important YOU! Behavioral Support Nutritional Support Program 1 year Health Bridge Tools For Medical Support Success Support Group Surgery Personal Trainers

9 Program Overview Attending the information session today Watch EMMI online the link will be sent to your Consultation with the Surgeon 1 hour screening with Bariatric Nurse 1 hour screening with Dietitian Psychological Evaluation with clinician of your choosing 2-3 hour classes with Nurse, Dietitian and a Psychologist or Therapist Pre-operative group meeting with Surgeon/Nurse Practitioner, Nurse & Dietitian Surgery Follow-Up Post operative - I year Free Centegra Health Bridge Fitness Center 2 Fitness Sessions with Personal Trainer

10 Nutrition after Bariatric Surgery Our Nutrition Commitment to You Education & Support Prevent side-effects and complications after surgery Promote appropriate and adequate weight loss Surgery is restrictive-we will teach you how to get the most of what you eat Emphasis on preventing vitamin & mineral deficiency through supplementation Your Commitment to You and the Team Follow-up with the Bariatric Center Team Lifetime adherence to a low-fat, low-sugar diet Portion Control and Balanced Diet Lifelong vitamin & mineral supplementation Learn to eat slowly and allowing time for the food to enter the new stomach Learn to take small bites and chew food well No Carbonated beverages

11 Nutrition learn to eat all over again Protein First 10 Day Pre-Op High protein diet protein supplements, non starchy veggies, select fruits Clear Liquid Phase Full Liquid Pureed Foods Soft Foods Regular Consistency Foods Low fat and no added sugar for life No counting calories, carbohydrates or points We support you through the whole process

12 Psychological Evaluation Initial evaluation: Written True/False Exam Consultation with the Psychologist: Eating Habits Family and Social history Assess and Evaluate your coping mechanisms Past Psychiatric History Assess your knowledge and understanding of pre/post surgical Expectations Identify potential emotional and psychological barriers This meeting also allows you time to build rapport with a clinician for some this support may be important for success

13 Post-Op Follow Up Care Critical for long term success and maintenance Monitor Progress -- Nutritional Health -- Support Meet with Nurse, Dietitian and Nurse Practitioner or Surgeon Week 1: Remove staples and Drain Week 5: Released for all Activities receive Health Bridge Membership Week 9: Final Meeting with Nurse and Dietitian Meet with Nurse Practitioner or Surgeon Months 4, 6, 12, 18 and then annually Month 6: Repeat initial lab tests

14 Your Role Accurately and thoroughly complete your health history questionnaire and return it to Huntley office. Learn all you can about the surgery before making a decision to proceed Ask all questions or concerns you have Follow all instructions as outlined by our program Attend all mandatory pre-operative education Remain committed to follow-up care for life How long does it take Screening Process Approximately 2-4 Weeks Insurance Approval Process 4-6 Weeks Pre-Op Process 2-3 Weeks 8-12 Weeks on Average *plus any additional insurance requirements

15 Introduction of Practitioners

16 Amir Heydari, M.D., F.A.C.S Minimally Invasive Bariatric and General Surgery Medical School University of Colorado Residency University of Iowa Fellow American College of Surgeons Fellow American Society of Bariatric Surgeons Member American Society of Bariatric Physicians

17 Amanda Butler FNP, NP-C, MSN Nurse Practitioner Bariatric and General Surgery Bachelors of Science in Nursing Purdue University Masters of Science I Nursing and Family Nurse Practitioner degree Olivet Nazarene University Member of the American Association of Nurse Practitioners (AANP)

18 Body Weight Classification by BMI Classification BMI U.S. Population Underweight Normal < Overweight > % Obese (Class I) Moderately Obese Obese (Class II) Severely Obese Obese (Class III) Clinically Severe > % Of the U.S. Population are Overweight or Obese cdc.gov 2016

19 Multifactorial Disease Obesity threatens to become the foremost cause of chronic disease in the world. Leptin Gene Genetic Social Stress Sedentary Lifestyle Increase d plate and serving sizes Technology Economic Class Increased Food Supplies Urbanization of the population Environmental Behavioral Fast Food Processed Food

20 Obesity Facts ~ Trends In 1960 the obesity rate was 13% Obesity has increased to nationwide epidemic proportions Adult obesity rate was 36.5% ( National Center Health Statistics) Obesity rate for year olds was 21% ( NCHS) Approximately 70% of U.S. adults are overweight (BMI>25) or obese (BMI>30) a total of over 175 million Americans (population 2016 Census) Obesity and overweight combined accounts for 300,000 deaths per year second only to those attributed to tobacco (NIH) The estimated annual health care costs of obesity-related illness are a staggering $190.2 billion includes: Absenteeism, loss of future earnings and premature death l

21 Co-morbid Conditions - Complications of Obesity Of these: almost 80% of obese adults have one of the following and 40% two or more Type 2 Diabetes Mellitus Peripheral Vascular Disease Glaucoma Kidney Disease Retinopathy Cardiovascular Conditions Hypertension Dyslipidemia Coronary Artery Disease Cardiomyopathy Stroke Cancers Endometrial Colon Breast Polycystic Ovarian Disease Infertility Gallstone Disease Musculoskeletal Injuries Premature Death Obstructive Sleep Apnea Non-Alcoholic Steatohepatitis Osteoarthritis

22 Taken together, the diseases associated with morbid obesity markedly reduce the odds of attaining an average life span and raise annual mortality tenfold or more. American College of Surgeons, Recommendations for facilities performing bariatric surgery, ST-34, Bull Am Col Surg, 2000;85:

23 Anatomy before Bariatric Surgery Esophagus Gallbladder Liver Stomach Small Intestine Large Intestine Rectum

24 Bariatric Surgery Today Four Types of Most Commonly Performed Bariatric Surgery Procedures Malabsorptive Restrictive Combination Restrictive Biliopancreatic Diversion w/ Duodenal Switch Vertical Sleeve Gastrectomy Roux en Y Gastric Bypass Adjustable Band Gastroplasty

25 Vertical sleeve new stomach pouch The stomach is restricted by stapling and dividing it vertically and removing more than 85% removed portion stomach This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc) Function of the stomach is preserved

26 Vertical sleeve This procedure generates weight loss solely through restriction (reduced stomach volume) Vertical Sleeve Gastrectomy is the most common bariatric surgical performed since 2014

27 Roux en Y Gastric Bypass Description A small, 20 to 40ml pouch is created at the top of the stomach. The small bowel is divided and is brought up to the pouch and is reattached (Roux Limb) The other end is connected to the lower portion of the small intestine (Y Limb) The small pouch releases food slowly causing a sensation of fullness with very little food. The biliopancreatic limb preserves the action of the digestive tract

28 Roux en Y Gastric Bypass How it works: Small Pouch Small opening from the pouch to the intestine Bypassed intestine Combination of malabsorptive & restrictive 1967 Mason, Ito, et al. The University of Iowa Hospital and Clinics

29 Adjustable Gastric Band What it is: Inflatable gastric band creating an hour glass shape to the stomach High level of compliance is required for success How it works: A small pouch is created By adding or removing saline the band become more restrictive Adjustments are made to meet individual weight loss needs Your stomach holds less food You feel full faster and longer

30 ASMBS July, 2016 Estimate of National Bariatric Surgery Numbers Total 158, , , , ,000 RNY 36.7% 37.5% 34.2% 26.8% 23.1% Band 35.4% 20.2% 14% 9.5% 5.7% Sleeve 17.8% 33% 42.1% 51.7% 53.8% BPD/DS 0.9% 1% 1% 0.4% 0.6% Revisions 6% 6% 6% 11.5% 13.6% Other 3.2% 2.3% 2.7% 0.1% 3.2%

31 Laparoscopic Roux-en Y Bypass & Sleeve Complication Rates Study Centegra (2016) 30 day post Mortality 1 0.3% 0% Leak Rate < 3.0 % <1% PE Rate < 1.5 % 0% Hernia Rate < 1.8% <1% Wound Infection Rate < 2% 1% 1 Smith MD, Patterson E, Wahed AS, et al. 30-day Mortality after Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery. Obesity Surgery. 2011):

32 Resolution of Medical Problems Having surgery is not a guarantee for weight loss. It is designed to be a tool, one of many that will allow you to retrain your eating habits and begin to make the lifestyle changes necessary to achieve and maintain weight loss. After Bariatric Surgery Migraines 57% resolved Depression 47% reduced Obstructive Sleep Apnea 74-98% resolved High Cholesterol 63% resolved Asthma 69% resolved Hypertension 69% resolved Fatty Liver (NASH) 90% reduced Metabolic Syndrome 80% resolved GERD 72% resolved Type 2 Diabetes 82-98% resolved PCOS Urinary Stress Incontinence 44% resolved 100% resolution menstrual dysfunction OA DJD 41% resolved Venous stasis 95% resolved Gout 72% resolved Relative risk of mortality Reduced by 89% in a five year period Quality of life improved In 95% of patients Ethicon summary of data from Brethauer S, Hammel J, Schauer P. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases. 2009; 5(4):

33 M I S C O N C E P T I O N S Most people who have bariatric surgery will regain their weight Studies have found that most bariatric surgery patients maintain successful weight-loss long-term (successful being defined as weight loss equal or greater than 50% of excess body weight with program adherence and follow-up Being obese is safer than bariatric surgery Data shows up to an 89% reduction in mortality - also highly significant decreases in mortality rates due to specific diseases Benefits of bariatric surgery health benefits far outweigh the risks The risk of death within 30 days following bariatric surgery is less than other operation including gallbladder Bariatric surgery is the easy way out just diet and exercise The National Institutes of Health Experts Panel recognize that long-term weight-loss, or in other words, the ability to maintain weight-loss, is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery Bariatric patients have serious health problems due to vitamin and mineral deficiency Nutrient deficiencies following surgery can be avoided with appropriate diet and the use of dietary supplement With follow-up and compliance nutrient deficiencies and any associated health issues are preventable *Data from ASMBS American Society of Metabolic and Bariatric Surgery

34 Endorsements American Diabetes Association - There is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. (ADA,2016) American Diabetes Association - The Diabetes Surgery Summit-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. (ADA,2016) American Heart Association - While there are risks, bariatric surgery is considered a relatively safe procedure, especially in centers that perform many of the procedures. (AHA, 2011) American Heart Association - Bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults. (AHA, 2011) Medicare - "In the right hands, bariatric surgery can benefit patients," Centers for Medicare and Medicaid Services, which sets policy for the federal health program. (CMS, Steve Phurrough,2006)

35 Who is Eligible for Bariatric Surgery? Patients having a Body Mass Index > 40 kg/m2 or a 100 lbs. or more overweight Patients having a Body Mass Index between 35 and 39.9 kg/m2 with significant co-morbidities Patients who have failed other medically managed weight-loss programs 9% of the U.S. Adult Population (Over 20 Million People) Meet These Criteria Who is Not a Candidate for Bariatric Surgery? Obesity related to a metabolic or endocrine disorder History of substance abuse or untreated major psychiatric disease Patients who surgery will not improve quality of life or life expectancy Woman who want to become pregnant within the next 18 months Unwilling to give up carbonated beverages Unwilling to give up smoking NIH Consensus Panel recommendations:

36 Next Steps Return your completed Health Questionnaire from tab 2 Complete the online Educational Program Emmi Consult with Surgeon Initial screening consultation with Nurse and Dietitian Schedule Psychological Evaluation Satisfy all insurance requirements Documentation will then be submitted to insurance Attend 2 Pre-op classes Once approved surgery date is set Pre-op testing is completed

37 Bariatric Surgery is currently the most safe and effective long-term intervention for the treatment of severe obesity and comorbid medical problems NEJM 2012, J. Intern Med 2013

38 Join our Team Better Health Wellness Less Medications Physical Fitness We will support, educate, and care for... You! Jamie Reaching Goals Education Support longevity

39 T h a n k Y o u... & Please leave your evaluation