Learning To Lean On Others Finding the right support system in your surgical journey Tracy Martinez RN,BSN,CBN Bariatric and Metabolic surgery has been proven to be the most effective therapy in the treatment of severe obesity 1
Contributing Factors of Severe Obesity Genetic Environmental Psychological Medical Co-Morbidities Pulmonary disease Abnormal PFTs Obstructive sleep apnea Hypoventilation syndrome Liver disease Steatosis NASH Cirrhosis GERD Stroke Gynecologic/Urologic abnormalities Abnormal menses Infertility PCOS Osteoarthritis Stress incontinence Depression Cardiovascular disease Diabetes Hyperlipidemia Hypertension Metabolic Syndrome Gall bladder disease Cancer Breast, uterus, cervix Colon Prostate Phlebitis PCOS = polycystic ovarian syndrome Gout NASH = nonalcoholic steatohepatitis NIH/NHLBI. September 1998; NIH publication no. 98 4083. Premature Death 2
Severe Obesity is a Chronic Disease Lifelong attention and efforts should be focused on keeping this disease at bay It Takes A Village NIH,ASBS/SAGES,ACS Surgeon Nutrition Obesity medicine Support Groups PATIENT Psychology Nursing Exercise Education 3
Long Term Success Checklist Nutritional Physical Medical Medical Team Surgeon, nursing, bariatric medicine Clinical expertise Educational skills Availability Set up for long-term follow up 4
Harris Interactive Study 409 post bariatric pts surveyed Those with close f/u lost 123lbs at one yr versus those with poor f/u who lost 92 lbs At 5 yrs most compliant lost 127lbs versus less compliant with a 100lb weight loss. June 2008 Behavioral Health Professional and self evaluation Tips for success Red flags and warning signs Enhance compliance 5
Exercise/Fitness Coordinator Motivational Specifically educated Prevent lean muscle mass loss Maximize BMR Individualized Resistance Training Benefits Assessment of Caloric Expenditure in GB Pts Muscle mass preservation is fundamental for maintaining optimal basal metabolic rates. BMR is accounted for over 70% of the total energy expenditure: if there is lean muscle mass loss, total expenditure drops causing difficulty in weight loss and weight maintenance. SOARD, Vol 6 May/June 2010 6
In a prospective study of bariatric pts and self reported exercise, Metcalf et al found that exercisers lost 28% more fat loss and retained 8% more lean body mass compared to those who didn t exercise. Exercise Exercise Becoming physically active after bariatric surgery is associated with improved weight loss and health related quality of life. >150 min IPAQ and Med Outcomes Study (SF-36) Bond et al Brown Albert Medical School 7
Nutritional Support Registered Dietician Dietary counseling Vitamin supplementation Nutritional educator Muscle mass preservation Program Support Integrated Team Support group Life long follow up Walking groups/group classes Annual retreats Newsletters Educational materials Continued lab surveillance Back on track classes 8
Program Support Elkins et al found that behavioral non compliance was pervasive at 12 months post RYGB. Apovian et al Obesity 2009 The Purpose of Support Group Brings individuals together focusing on similar issues, concerns and goals Social connection Helps empower Stress management Implements coping skills Open dialogue without judgment Practical, appropriate accurate advice 9
Importance of Support Group Attendance Support Group participation has been associated with greater weight loss after bariatric surgery. Obes Rev 2010 Feb 2010 Importance of Support Group Attendance Patients that attended support groups regularly lost more weight, and tended to lose more weight with increased frequency Obesity Surg,8,1998 10
Support Group Meetings Should meet at regular intervals Integrated Team participation Confidential Respectful Facilitated by a credentialed IHTM Words of Wisdom Surround yourself by a supportive tribe 11
Words of Wisdom Accept that you have a chronic disease Words of Wisdom You did not take the easy way out 12
Words of Wisdom Change your lifestyle Change your attitude Keep yourself accountable Commit to long term follow up Words of Wisdom When you are ready to learn the teacher will arrive. 13
Every human being is the author of his own health or disease Buddha Happiness is when what you think, what you say and what you do are in harmony Mohandas Gandhi 14
Learning to Lean on Others by Tracy Martinez and Barbara Thompson Why Support Groups Are Important Stay on track New things to learn Tracking New patients want to talk with experienced patients 15
Why Patients Don t Attend Support Groups Patients/Surgeons move No longer relevant Life gets in the way Patients feel they know it all Lack of privacy Regain weight How to Keep Patients Coming Keep groups relevant Optional weigh-ins Give them roles Buddy system with new patients 16
What Happens When Patients Stop Coming Nothing Regain weight Patients health may suffer Turn to online groups 17
Rise of Online Groups Always been based on the need for using peer support for practical information Information, support and a broad range of friendships Need for community 18
Online Support (Cybersolace) Obesity Help forums Yahoo groups OSSG (Obesity Surgery Support Groups) Facebook Blogs Twitter Problems With Online Groups Not moderated Advice from lay people Solution: professionals become more active in the online community 19
Problems With Online Groups cont. We are a population that sometimes needs more F2F contact with the world Communication can be misunderstood When Online Groups Are Good More constant and immediate support Relevant connection Access to broader awareness OAC and online groups 20
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