nutritional trends and implications for weight loss surgery
TRANSCRIPT
https://learn.extension.org/events/2550
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
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• 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
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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 IIISuper 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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Types of Bariatric Surgeries
14Photo 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 BandUnfilled 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
Descendingduodenum
Food absorbed
Mouth
Proximalgastric 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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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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35Photos 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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