Welcome

To the

Water Tower

Surgery

Weight Loss Center, SC

Patient Information

Session

MEET OUR SURGEON

Dr. Frederick Tiesenga

WHAT IS OBESITY?WHAT IS OBESITY?

• Obesity is an excess of body fat frequently resulting in a significant impairment of health (NIH Consensus Statement, 1985)

OBESITY: OBESITY: CONTRIBUTING FACTORSCONTRIBUTING FACTORS

A simple explanation given

for obesity is overeating.

OBESITY:OBESITY:CONTRIBUTING FACTORSCONTRIBUTING FACTORS

• Endocrine (hypothyroidism, etc.)• Genetic influence (?Ob gene, etc.): increased rate

accumulation fat, more fat cells, larger fat cells. Increased fat storage?

• Psychological factors: depression, low self-esteem, social anxiety, poor stress management skills.

• Social factors: social relationships (family, friends, social and business clubs) with activities planned involving eating.

OBESITY BY THE NUMBERSOBESITY BY THE NUMBERSThe percentage of Obese American Adults almost doubled since 1960

(American Obesity Association, 1999)U.S. AdultPopulation

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

1960 1980 1999

22.50%16.50%12.80%

39 MILLION

OBESITY BY THE NUMBERSOBESITY BY THE NUMBERS

• Nearly 25 percent of American children and adolescents are overweight – double the percentage from 30 years ago.

• About 5 to 10% of children are obese.

OBESITY BY THE NUMBERSOBESITY BY THE NUMBERS

• Between 13 and 23% of all adolescents are obese.

• 80% of obese teenagers are likely to grow into obese adults.

OBESITY:OBESITY:HEALTH CONDITIONSHEALTH CONDITIONS

• Poor diet and sedentary lifestyle are responsible for between 300,000 and 587,000 deaths per year, making obesity the second leading cause of preventable death after smoking

• Obesity is an independent risk factor or an aggravating agent for approximately 30 conditions

OBESITY:OBESITY:CO-MORBIDITIESCO-MORBIDITIES

• Diabetes• Gallbladder disease• Heart Disease• Osteoarthritis and gout• Rheumatoid Arthritis• Pulmonary problems and

sleep apnea

• Cancer (Breast, Colorectal, Endometrial)

• Renal Disease• Hypertension• Liver Disease• Stroke• Urinary Incontinence

OBESITY:OBESITY:CO-MORBIDITY FACTSCO-MORBIDITY FACTS

• 80% of NIDDM patients are obese• 70% of diagnosed cases Cardiovascular

disease are related to obesity• For each 10% increase in body weight: 20%

increase in CAD, systolic blood pressure increases 6.5mmHg, plasma cholesterol 12 mg/dl, fasting blood glucose 2mg/dl

(Obesity and Health-An Overview, 1999)

DIRECT COST RELATED TO DIRECT COST RELATED TO OBESITYOBESITY

0% 5% 10% 15% 20% 25% 30% 35%

CHD

Diabetes

HTN

Stroke

Arthritis

Cancer

Others

21%5%7%8%9%20%30%

(The Lewin Group Study, 1999)

BODY MASS INDEX (BMI)BODY MASS INDEX (BMI)

• THE CURRENT BEST METHOD TO MEASURE OBESITY

• Is a simple math calculation that determines weight-to-height ratio.

• IT CAN BE CALCULATED USING the formula: kg/m2 (or lbs/inches2 X 704.5).

BMI RANGESBMI RANGES(Metropolitan Life insurance Company table data)

• < 19 UNDERWEIGHT• 19-25 NORMAL• 26-29 OVERWEIGHT• 30-40 OBESITY• > 40 MORBID OBESITY BMI 40 = APPROX 100 lbs above desirable weight

PROBLEMS OF MORBID PROBLEMS OF MORBID OBESITYOBESITY

10% people in USA are morbid obese

BMI>30 (Obesity):55% increase in mortality, 70% increase from CAD, 75% increase from stroke, 400% increase from diabetes (American Obesity Association)

Morbidly obese young men between the ages of 25 and 35 have 12 times the chance of dying as men of normal weight.

A morbidly obese adult has only one-third the chance of living to age 65 as that of a person who is of normal weight.

REDUCED LIFE REDUCED LIFE EXPECTANCYEXPECTANCY

0

50

100

150

200

250

300

20 - 25 26 - 35 36 - 45

High RiskMod. RiskLow Risk

MORTALITYRATIO %

Body Mass Index (Kg/m2)NIH, NEJM. 1995

PROBLEMS OF MORBID PROBLEMS OF MORBID OBESITYOBESITY

Physical Limitations:• Particular difficulties

can occur with:• Sporting and outdoor

activities• Clothes• Personal hygiene• Travel

Psychosocial Disability:

• Low self-esteem• Low self confidence• Reduced

employability• Depression• Decreased Libido• Social isolation

Medical therapy for obesityMedical therapy for obesity

Dieting Behavior Modification Regular Physical Exercise Drugs (malabsorptive,

appetite suppressants, etc.) Support groups (weight

watchers, etc.)

MEDICAL THERAPY FOR MEDICAL THERAPY FOR OBESITYOBESITY

What are the realistic expectations?An optimal and continuous program which

uses: diet, tablets, behavior modification and exercise

can expect to achieve and maintain a weight loss of 10 kg (22 lbs) if continued permanently

95% return to pre-diet weight (Adkinson, Am J. Clinical Nutrition, 1994)

What are the Options between What are the Options between Medical and Surgical Treatment?Medical and Surgical Treatment?

There are none!!!

SURGICAL THERAPY FOR SURGICAL THERAPY FOR OBESITYOBESITY

GOAL of Obesity Surgery:

• Improve Health

• Improve Quality of Life

• Increase the Duration of Survival

LAPAROSCOPIC ADJUSTABLE GASTRIC LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAP-BAND)BAND (LAP-BAND)

• The capacity of the stomach is made smaller by placing an adjustable band around the upper part of the stomach.

• No cutting or stapling • The feeling of satiety

(fullness) is achieved when the small stomach pouch above the band is full.

LAP-BAND SURGERYLAP-BAND SURGERY

It is a Laparoscopic surgery AdjustableReversibleShort Hospital Stay

• hospital stay is < 24 hours

Quicker recovery:• walking/drinking liquids in 4-6 hours after surgery, normal

activities in few days Less Morbidity/Mortality than any other operation for

Morbid Obesity

LAP-BANDLAP-BANDSLIPPAGESLIPPAGE

LAP-BANDLAP-BANDSLIPPAGESLIPPAGE

O’Brien Study (302 patients) 1999:No.

slippages

• First 50 patients: 15• Second 50 patients: 7• Third 50 patients: 3• Fourth 50 patients: 2• Last 100 patients: 0

Recovery Time

• For the Lap Band you can expect to be back to work in about two weeks.

• If you are currently taking medication, please alert your surgeon so they can discuss your prescription treatment with your primary doctor.

Diet Post-OpDiet Post-Op

• The First One to Four Weeks: Liquids and very soft food (soup, yogurt, juices, jello, skim milk, etc.).

• Four to Six Weeks: Slightly thicker diet. Switch gradually to solid food.

Lap Band Diet Post-OpLap Band Diet Post-Op

After Six Weeks:• Solid food following this rules:

Eat three small meals a day Eat slowly and chew

thoroughly Stop eating when felling full Do not drink while eating Avoid fibrous food Drink enough fluids during day

GB/VBG/LAP-BANDGB/VBG/LAP-BANDRESULTSRESULTS

0

10

20

30

40

50

60

70

80

90

3 6 9 12 18 24 36 48

Gastric Bypass

Vertical BandedGastroplastyLap-Band

% EWL

Months

DIABETESDIABETES

O’Brien Study (Australia, 1999) 302 patients:• 9.7% diabetics• 54% became “non-diabetics” (no sx, no Rx,

nl biochemestry)• 43% were improved (easier to control, less

Rx, improved biochemestry)• One pt. Remained unchanged

HYPERTENSIONHYPERTENSION

O’Brien Study (1999):• Prevalence 33%• At 12 months: Out of 88 patients with HTN, 75

had normal BP, and only 27 were on Rx.

Outcome:Resolved (nl BP, no Rx) 52 (59%) Improved (Easy control, less Rx) 29 (33%)Unchanged 7 (8%)

LAP-BANDLAP-BANDRESULTSRESULTS

287 lbs/BMI 46.3Sep. 26, 2001

165 lbs/BMI 27 !!!April 30 , 2002

LAP-BANDLAP-BANDRESULTSRESULTS

224 lbs/BMI 36June 25, 2001

149 lbs/BMI 23!!!Feb. 1, 2002

LAP-BANDLAP-BANDRESULTSRESULTS

379.9 lbs/BMI 66Oct. 17, 2000

229 lbs/BMI 39!!!Feb. 1, 2002

LAP-BANDLAP-BANDRESULTSRESULTS

263 lbs/BMI 41Dec. 1, 2000

190 lbs/BMI 29!!!Dec. 1, 2001

LAP-BANDLAP-BANDRESULTSRESULTS

292 lbs/BMI 43.2Mar. 25, 2001

217 lbs/BMI 32!!!Mar. 8, 2002

LAP-BANDLAP-BANDRESULTSRESULTS

273 lbs/BMI 43.3Nov. 30, 2000

171 lbs/BMI 27 !!!Mar. 1 , 2002

Lap-Band PatientLap-Band Patient77 lbs in 14 months77 lbs in 14 months

262 lbsJuly 24,2002

210 lbsApril 30, 2003

185 lbsOctober 8, 2003

Lap Band Patient 75 lbs weight loss in 8 months

315 lbs

November 18, 2002240 lbs

October 9, 2003

Our Pre-Op Screening

• Medical Evaluation with one of our surgeon• Nutritional Evaluation• Psychological Evaluation • Labs (CBC, CMP, U/A, Lipid profile, pregnancy

test, Upper GI and ultrasound if necessary) • Minimum Follow up: One year

Our qualification process…

• Complete the patient information packet in its entirety and return it as soon as possible.

• We will then complete an insurance benefit verification with your insurance on what your bariatric coverage may be.

• Once we have determined your coverage and received and reviewed your packet, we will contact you for additional testing that may be needed (Psych & Dietary).

What you can expect on your first visit…..

• One on One Consultation with the surgeon.

• Review any pre-surgical care that may be needed.

Pre-Surgical Financial Consultation

If your insurance requires you to satisfy a deductible or co-insurance amount, we ask

that you pay that prior to your surgery.

If you are a self-pay patient, financial arrangements must be done prior to your

surgery.

QUESTIONS and ANSWERS???