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Pre and Post Natal Care Challenges with Obese Patients
BRAD THAEMERT, MD FACSSURGICAL INSTITUTE OF SOUTH DAKOTA, PC
Agenda
Obesity awareness
Value of bariatric surgery
Review of bariatric surgeries Surgical and non-surgical options
Nutritional deficiency
Obesity Awareness Obesity is THE
major public health concern. Greater than heart
disease, smoking, etc.
Finally widely recognized as a disease in 2013
Excess fat contributes to chronic health conditions.
Category BMI Range
Normal Weight 18.9 to 24.9
Overweight 25 to 29.9
Class I, Obesity 30 to 34.9
Class II, Serious Obesity 35 to 39.9
Class III, Severe Obesity 40 and greater
BMI (Body Mass Index): a measure of body fat calculated using a person’s height and weight
Body Mass Index
Women of reproductive age in the US: 30.2% obese56.7% overweight
Obesity rates in the adult female population:Race Obesity RateNon-Hispanic/African-American 48.8%Hispanic 38.9%Non-Hispanic/Caucasian 31.3%
Obesity in America
Obesity in Pregnancy
Mother’s BMI Recommended Weight Gain During Pregnancy
Normal (BMI 18.9 to 24.9) 25-35 lbs.
Overweight (BMI 25-29.9) 15-25 lbs.
Obese (BMI 30+) 15 lbs.
Risks of short and long term complications for mother and fetus.
Affects metabolic and hormonal environment of developing fetus.
Possibly changes structures in the brain that regulate appetite and metabolism, affecting person lifelong.
Obesity in children increased 11% from 1994 to 2000.
Source: The Impact of Maternal Obesity on Maternal and Fetal Health, Meaghan A Leddy, Michael L Power, Jay SchulkinRev Obstet Gynecol. 2008 Fall; 1(4): 170–178, PMCID: PMC2621047
Source: The Impact of Maternal Obesity on Maternal and Fetal Health, Meaghan A Leddy, Michael L Power, Jay SchulkinRev Obstet Gynecol. 2008 Fall; 1(4): 170–178, PMCID: PMC2621047
Nutritional Deficiencies
Vitamin % of Patients DeficientThiamin 15-29%B12 2-18%
Folate 54%Iron 45%Vitamin A 7%Vitamin D 60-70%
Pre Weight Loss Surgery
Weight Loss Options
Method Success Diet & Exercise Poor Meds Poor Hypnosis Poor Non Surgical Procedure Good Surgical Procedure Excellent
Value of Bariatric Surgery Bariatric surgery is the most
effective treatment for morbidly obese patients.
Bariatric surgery is a metabolic surgery and improves or resolves many comorbid conditions.
Clinical evidence shows that the risks of being morbidly obese outweigh the risks of surgery.
Comorbidity ResolutionProcedure HTN Diabetes Hyperlipidemia Sleep
ApneaGERD
Sleeve Gastrectomy 65% 60% 75% 60% 75%
Roux-en-Y Gastric Bypass 75% 80% 85% 75% 95%
Procedure % Excess Weight Loss % Total Weight Loss
Sleeve Gastrectomy 65% 30%
Roux-en-Y Gastric Bypass 75% 35%
Outcomes at 2 Years
Surgical OptionsSleeve GastrectomyRoux-en-Y Gastric BypassGastric Band/Lap Band
Non-Surgical OptionsORBERA Intragastric BalloonEndoscopic Sleeve Gastroplasty (ESG)
Sleeve Gastrectomy
Gastric Bypass
Lap Band
ORBERA Balloon
Endoscopic Sleeve Gastroplasty
SummaryObesity prevalence increasing
with significant risk to mother and fetus.
Consider weight loss eval pre-pregnancy.
Beware of vitamin/mineral deficiencies in obese females prior to pregnancy.