nutritional trends and implications for weight loss surgery€¦ · gain (not to promote weight...
TRANSCRIPT
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.
Nutritional Trends and Implications
for Weight Loss Surgery
Connecting military family service providers
and Cooperative Extension professionals to research
and to each other through engaging online learning opportunities
www.extension.org/militaryfamilies
MFLN Intro
2 Sign up for webinar email notifications at www.extension.org/62831
• 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.
Today’s Presenter
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Ashley McCartney, MS, RD, LDN
By: Ashley R. McCartney, MS, RD, LDN
Carle Physician Group
Urbana, IL
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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
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Photo taken from www.stateofobesity.org
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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
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Photo taken from www.stateofobesity.org/healthcare-costs-obesity/
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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
Classification of Obesity
Photo taken from WHO
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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
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Photo taken from www.happyhungryhealthy.com
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• 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?
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Types of Bariatric
Surgeries
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Photo taken from www.lourdes.com
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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
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Diabetes 50%
Dyslipidemia 50%
Hypertension 60%
Sleep apnea 90%
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Band slippage
Leakage of tubing / balloon
Port or band infection
Obstruction
Nausea / vomiting
Band erosion into stomach
Esophageal dilatation
Failure to lose weight
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Diet progression
Portion sizes
Vitamin regimen
Physical activity regimen
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Filled Band Unfilled Band
Photo taken from www.mylapsurgeon.com
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Vertical Sleeve Gastrectomy
Photo taken fromwww.darylsmarxmd.com
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Restrictive Procedure
Irreversible
Popularized in early 2000s
Still under research for efficacy
How does the sleeve function?
Rate of weight loss
Inpatient hospital stay
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Diabetes 80%
Dyslipidemia 60%
Hypertension 60%
Sleep apnea 95%
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Leaks 1-2%
Strictures <1%
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Diet progression
Portion sizes
Vitamin regimen
Physical activity regimen
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Bile duct
Pancreas
Descending
duodenum
Food absorbed
Mouth
Proximal
gastric pouch
To rest of bowel
Jejunum
Photo taken from www.browardsurgicalspecialists.com
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Malabsorptive procedure
Reversible
Developed in the 1960s
How it functions
Rate of weight loss
Why is bypass considered “the gold standard?”
Inpatient hospital stay
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Diabetes 90%
Dyslipidemia 70%
Hypertension 65%
Sleep apnea 90%
Reflux 98%
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Diet progression
Portion sizes
Vitamin regimen
Physical activity regimen
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• 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?
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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
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Photos taken from www.bariatricnews.netand www.binghammemorial.org
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No deaths
10% SAE’s
19% had balloon removed early
Nausea, vomiting, abdominal pain, reflux in
48-72 hrs.
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BMI 30-40
In conjunction with long term diet/behavior
modification program
Failed more conservative teatments
Maximum duration of placement 6 mos.
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Reasonable option for temporary weight loss
Very skeptical about long term weight loss
efficacy
High potential for inappropriate use
Most beneficial indications are currently off-
label
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Biliopancreatic diversion
Biliopancreatic diversion with duodenal
switch
Silastic ring gastric bypass
Endoscopic sleeve gastroplasty
Vbloc
AspireAssist
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Photo taken from www.drsamuelbledsoe.com
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Expected Outcomes References
First Trimester
Second Trimester
Third Trimester
Post-Partum
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.
A band fill will be performed no earlier
than 14 weeks gestation or later if
weight gain is excessive.
All fluid will be removed from the band
at 36 weeks gestation.
A band fill will not be performed until
lactation is established. Band
adjustment will likely be close to pre-
pregnancy levels.
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.
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.
Reduce impact of band on delivery.
Initiate weight loss or weight
maintenance.
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.
Carle Foundation Hospital:
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Timing of pregnancy
Recommended lab work
Protein requirements
Weight gain
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Surgery for pregnancy
Sports nutrition- i.e. marathons, etc.
Surgery for other medical procedures
Photos from: www.7leafmarketing.com
www.karatebyjesse.com
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"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: Payer-and 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.
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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-and-
wellness/
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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.