Nutritional Trends and Implications for Weight Loss Surgery https://learn.extension.org/events/2550 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 2014-48770-22587 and 2015-48770-24368.
MFLN Intro Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities www.extension.org/militaryfamilies 2 Sign up for webinar email notifications at www.extension.org/62831
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
By: Ashley R. McCartney, MS, RD, LDN Carle Physician Group Urbana, IL Ashley.McCartney@carle.com 4
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
Photo taken from www.stateofobesity.org 6
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
Photo taken from www.stateofobesity.org/healthcare-costs-obesity/ 8
Classification of Obesity Classification BMI Risk of Comorbidities Underweight <18.5 Low Normal 18.5-24.9 Average Overweight 25.0-29.9 Increased Obese Class I 30.0-34.9 Moderate Obese Class II 35.0-39.9 Severe Obese Class III Super Obese 40.0 49.9 >/= 50.0 Very severe Photo taken from WHO 9
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 www.reboundfreeweightloss.com and www.globalrugby.com.au 10
Photo taken from www.happyhungryhealthy.com 11
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
Types of Bariatric Surgeries 13
Photo taken from www.lourdes.com 14
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
Diabetes 50% Dyslipidemia 50% Hypertension 60% Sleep apnea 90% 16
Band slippage Leakage of tubing / balloon Port or band infection Obstruction Nausea / vomiting Band erosion into stomach Esophageal dilatation Failure to lose weight 17
Diet progression Portion sizes Vitamin regimen Physical activity regimen 18
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Unfilled Band Filled Band Photo taken from www.mylapsurgeon.com 20
Vertical Sleeve Gastrectomy Photo taken fromwww.darylsmarxmd.com 21
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
Diabetes 80% Dyslipidemia 60% Hypertension 60% Sleep apnea 95% 23
Leaks 1-2% Strictures <1% 24
Diet progression Portion sizes Vitamin regimen Physical activity regimen 25
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Mouth Proximal gastric pouch Jejunum Bile duct Pancreas Descending duodenum Food absorbed Photo taken from www.browardsurgicalspecialists.com To rest of bowel 27
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
Diabetes 90% Dyslipidemia 70% Hypertension 65% Sleep apnea 90% Reflux 98% 29
Diet progression Portion sizes Vitamin regimen Physical activity regimen 30
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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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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Photos taken from www.bariatricnews.netand www.binghammemorial.org 35
No deaths 10% SAE s 19% had balloon removed early Nausea, vomiting, abdominal pain, reflux in 48-72 hrs. 36
BMI 30-40 In conjunction with long term diet/behavior modification program Failed more conservative teatments Maximum duration of placement 6 mos. 37
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
Biliopancreatic diversion Biliopancreatic diversion with duodenal switch Silastic ring gastric bypass Endoscopic sleeve gastroplasty Vbloc AspireAssist 39
Photo taken from www.drsamuelbledsoe.com 40
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), 59-65. 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
Timing of pregnancy Recommended lab work Protein requirements Weight gain 42
Surgery for pregnancy Sports nutrition- i.e. marathons, etc. Surgery for other medical procedures Photos from: www.7leafmarketing.com www.karatebyjesse.com 43
"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. 2016. Allison DB, Fontaine KR, Manson JE, Stevens, J, Vanitallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16)1530-8. Cawley J and Meyerhoefer C. The Medical Care Costs of Obesity: An Instrumental Variables Approach. Journal of Health Economics, 31(1): 219-230, 2012; And Finkelstein, Trogdon, Cohen, et al. Annual Medical Spending Attributable to Obesity. Health Affairs, 2009. 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, 2007. 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, 2008. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable to Obesity: Payerand Service-Specific Estimates. Health Affairs, 28(5): w822-831, 2009. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric Surgery. A systematic review and meta-analysis. JAMA. 2004 Oria, HE. Gastric banding for morbid obesity. Eur J Gastroenterol Hepatol 1999;11:105-114 Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12:564-568. 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 http://win.niddk.nih.gov/publications/gastric.htm Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 2002;12:564-568. 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): 70-89 [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), 59-65. 44
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Nutrition and Wellness Upcoming Event Nutrition, Exercise, and Renal Disease Date: Tuesday, June 28, 2016 Time: 11:00 am Eastern Location: https://learn.extension.org/events/2655 For more information on MFLN Nutrition and Wellness go to: https://blogs.extension.org/militaryfamilies/nutrition-andwellness/ 49
www.extension.org/62581 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 2014-48770-22587 and 2015-48770-24368.