GUELPH

BARIATRIC CLINIC

Welcome to the Medical Bariatric Program

Information Session

Bariatric Centre of Excellence

Meet Our Team - Introductions

• Social Worker -Lisa Dickieson, MSW, RSW,CDE

• Registered Dietitian –Lisa Mooser, RD, MAN, CDE

• Endocrinologist -Dr. Liviu Danescu, MD, FACE

• Registration Clerk -Chantal O’Brien

About Our Program History

• This in NOT the Surgical Bariatric Program, rather, this is the Medical Bariatric Program and is in no way “tied” to the Surgical Program

• You cannot be on the waitlist for both Programs, and you can only participate in this Medical Program once in your lifetime (it is important to make sure this is the right time)!

• The Medical Program is not intended to be used as a bridging Program for those intending to pursue surgery

• Our Medical Program has been running since January of 2013 when the Government provided funding for many Medical Programs across the Province

Bariatric Clinic Surgical Option

• We also offer elective Bariatric Surgery at this Clinic

• Please grab a info sheet at the end of this session if you are interested

What is the Medical Bariatric Program?

• It is a medically supervised, behaviour change Program that has been designed with the long-term goal of improving overall health

• Changing habits is by no means a “quick fix” --The Medical Program involves weekly workshops that are focused on resetting baseline habits (“cognitive-behavioural” approach)

• This Program in delivered in a group fashion, which serves as a valuable support for many participants

Overview: Medical Program Referral to Program

Realistically a 1.5-2 year waitlist from the date of referral

24 Weekly Classes and Optifast Mandatory 24 weekly classes to reset lifestyle habits (to lose weight and improve health)

* Within the 24 weeks, 12 weeks with full meal-replacement shakes and 6 weeks of partial-shakes to transition back to foods

Support Group Meetings & Check-ins Optional To help stay on track, share tips and tricks

5 sessions (1 session each month)

1 and 2 year Doctor Appointments Mandatory

*Attend an information session

*Assessment appointments by team

(bloodwork and ECG completed)

Information Session: Is the Medical Program the Right Fit?

Future Assessment Appointments

1. Get bloodwork and ECG completed at least 1-week prior to your assessment appointment (requisition to be obtained from your Family Doctor)

2. Fill in the questionnaire booklet 3. Read and understand the Program

contract

If after today you decide to remain on the waitlist, the next step is to wait until you are called for your initial assessment

appointments These appointments will be booked a few months prior to starting the weekly Program…

Once we have booked your initial appointments with our Nurse, Dietitian and Social Worker, you are required to do the following before attending the appointment

After the Assessment Appointments

Should there be any concern with starting

the weekly Program at this time, the team will

discuss alternative options and next steps

of how to proceed.

After you’ve undergone the formal assessment

process at our Clinic, the team will determine

whether or not you are a suitable candidate to proceed at this time.

Weekly Classes

• Once you are assessed, assigned to a group and are given a start date, you are required to attend class each week with the same group for 24 classes (6 months)

24 Weekly Classes and Optifast Mandatory 24 weekly classes to reset lifestyle habits (to lose weight and improve health)

When we bring you in to be

assessed by our team, the

intention will be to get you

started you in the next

available class (it will be fore

a specific day and time)

*Class options fall between

8am-4pm on Tuesdays,

Wednesdays and Thursdays

Monthly Support Groups (Optional)

• After you complete the 24-weekly classes, you are invited to attend optional support groups once a month, for up to 5 months

• Support groups are a mixture of people from varying classes, who are all in the same phase having completed the weekly classes

Support Group Meetings & Check-ins Optional To help stay on track, share tips and tricks

5 sessions (1 session each month)

1 and 2 Year Nurse and Doctor Appt.

• After the weekly and monthly phases of the Program are completed, it is appreciated and recommended that you attend your 1 year and a 2 year follow-up appointments with our Nurse and Doctor

• These visits are intended to serve as an opportunity for you to touch base with our Nurse and Doctor (to discuss potential changes in the management of your health), as well to provide our funding source with information on your long-term weight and health status

1 and 2 year Doctor Appointments Mandatory

Set Yourself Up For Success…

• Weekly attendance is mandatory, due to many reasons…

Program is medically supervised

It is unfair/disruptive to other group members

HIGHLY related to your overall success!

Respect the fact that the Program is funded by the MOH (your attendance in the Program is paid for!!)

Attendance policy:

• Allotted 1-missed class (please call - we get that “life happens”); anything more, you will be discharged

• Due to the limited number of excused misses, it’s not acceptable to have planned travel requiring you to miss class

• Missed attendance will not count on days when it’s dangerous to be on the roads due to bad weather

Who Can Attend Classes?

• Classes are closed format (only patients enrolled in our Program are able to attend class)

• This is due to:

– Patient confidentiality

– Privacy of discussions in class

– Space available

• This includes children! – please make alternate arrangements should you have a sick child at home or on a P.D. day

The Cost of the OPTIFAST

• The only cost of our Program is directly related to purchasing the meal replacement shakes (Optifast)

• The shakes start after the 3rd class for 12-weeks (full meal replacement), followed by a 6-week transition of partial shakes

– During the 12-weeks the cost of the Optifast is $64 per week (totaling $768)

– The cost of the shakes used over the 6-week transition is $192 – The total cost of the shakes over the duration of the entire

Program is $960, but you only purchase a 1-week at a time

• **There are no exceptions to this purchasing requirement**

To date, Optifast has never been covered by any Government Assistance Programs or Insurance Plans

Full Meal Replacement Phase…

• 4 shakes daily (chocolate or vanilla)

• Drinking lots of water (3.0 litres daily)

• Supplementing with fibre as needed (i.e. Metamucil)

• Optional daily serving of No-Salt-Added broth

• Celery (~around 2 cups daily)

• Limited amount of coffee, tea and diet pop

• To create the most favourable metabolic response in the body, NOTHING ELSE is to be consumed during this phase!

Presentation Topics at a Glance…

Phase One:

• Setting up Your Environment, Get Your Supports in Place,

Optifast Details, Cravings and Triggers, Reducing

Sedentary Behaviours, Being Assertive

Phase Two:

• Low-Glycemic Carbs, All About Fat, Protein Needs, Lets

Get Active, Sodium 101, Balanced Meal Planning, Smart

Grocery Shopping, Exercise

Phase Three:

• Stress Reduction, Body Image, Maintenance,

Special Occasions, Relapse Prevention

Our Program Focus

• Each and every week our classes are led by both the Dietitian and Social Worker

• This allows us to not only focus on the most up-to-date nutrition literature, but it also allows us work on other aspects related to our overall relationship with food

• Attending classes and integrating and applying the learned information week after week, is ultimately what our Program is all about

• Optifast is a helpful tool but it is your hard work and sustained lifestyle behaviours that lead to life-long results

Privacy and Confidentiality

• Messages from the Clinic may be left on your voicemail, and we may also communicate with you over email, unless directed otherwise (all emails become a part of your file)

• We may access your records electronically from other hospitals, physicians and laboratories when necessary (this includes mental health records)

• We are a multidisciplinary team, therefore each Clinician will have access to all notes in your chart

• We are in communication with other health care professionals involved in your “Circle of Care”, to help improve the continuity of care received

Scent Reduction Policy

• Guelph General Hospital has a Scent Reduction Policy

• Please keep this in mind when attending appointments and classes at our Clinic

• Thank You !

What Can I Do To Prepare Myself

Before the Program Starts?

Start Sipping Water Throughout the Day

• While on the Optifast you will be required to drink lots of water

• Regardless of the Optifast phase, water is such a key component to a healthy lifestyle (so many processes in our bodies rely on water!)

• For now, it would be a good idea to start aiming for ~2.0 litres of water daily – Best option is water -- tap, bottled, bubbly (can add

lemon/lime wedge, cucumber slices, ginger wedge, herbal tea, etc.)

• Avoid drinking your calories (with the exception of up to 2 glasses of milk a day) by weaning off of sugar-sweetened beverages such as…

– Regular pop, juice, store bought smoothies, milkshakes, iced tea, Frappuccino, hot chocolate, lemonade, Gatorade, Red Bull, Fruitopia, etc.

• Calories from drinks can add an excessive amount of empty calories to your day

• Did you know that there are 10 tsp of sugar in a can of Coke??

Wean Off Sugary Beverages

Limit Your Intake of Diet Pop

• Although diet pop doesn’t have any calories, it contains significant amounts of artificial sweeteners, which can increase the body’s cravings for sugar (according to the outcomes of some research studies)

• During the Optifast phase and thereafter, it is recommended to limit your consumption of “diet pop” to no more than 2 cans daily (~about 24 ounces)

Limit Your Caffeine Intake

• During the Optifast phase and thereafter, it is best to limit yourself to 2 cups of caffeinated beverages daily, as a way to protect your overall health and prevent dehydration due to the diuretic effect of caffeine

• If you consume higher levels of caffeine on a regular basis, consider weaning yourself down to a maximum of 2 cups daily (to get a head start and to allow your body to adapt to lower levels of caffeine)

• Thinking Ahead: Cream, milk and sugar are NOT permitted during the Optifast phase (however sweeteners in moderation are okay if desired)

Purposeful Movement Daily

• Our bodies are all different, with varying abilities and with differing limitations and barriers

• Start small and gradually increase over time – try to build up to increments of 10 minutes or more, to total around 30 minutes most days

• Move a little bit more today then you did yesterday

Craving Change

• Craving Change is a Program that provides strategies on how to navigate problematic eating, by helping you understand personal triggers while building up a toolbox to help conquer problematic eating

A Few Books We Recommend…

• The G.I. Diet by Rick Gallop

• The Diet Fix by Yoni Freedhoff

• Food and Feelings Workbook by Karen R. Koenig

• Cognitive Behavioural Therapy Workbook for Weight Loss by Valerie Taylor

• The LooneySpoons Collection (recipe book) by Janet and Greta Podleski