Riverside Medical and Surgical Weight Loss Center

David Salzberg, M.D., Bariatric Surgeon

Felice Haake, D.O., Medical Bariatrician

757-637-7637

60% (34 million) of Americans are overweight

25% of American children are overweight

6% of health care expenditures ($238 billion / year)

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Economic…..

•National cost = $200 billion

$93 Billion in medical bills

$33 Billion on weight-loss products

$74 Billion in “Absenteeism”

The Personal Cost of Obesity

ITEMS Estimated Annual Costs

Mean medical/drug costs (BMI 35)1 $ 5,965

Out-of-pocket healthcare expenses2 $ 2,182

Employment inactivity costs3 $ 900

Commercial weight loss program fees4 $ 600

Prescription co-pays (5 meds at $10) $ 600

Grocery and dining costs5 $ 5,321

TOTALTOTAL $15,568 $15,568

References: 1. Health Management Research Center, University of Michigan, 2001; 2. U.S. Bureau of Labor Statistics, Consumer Expenditures in 2001; 3. Source: Colditz, GA.

“Economic costs of obesity and inactivity,” Med Science Sports Exercise, 1999; 4. Marketdata Enterprises, Inc., 10/02; 5. U.S. Bureau of Labor Statistics, Consumer Expenditures in 2001

Change in the cost of living after weight-loss surgery can be dramatic

300,000 deaths annually

Prevalence of Medical Co-Morbidities Attributable to Obesity

Relative Risk of Cancer - Men

Relative Risk of Cancer- Women

A typical fast food meal

•Big Mac: 570 kcal•Large Fries: 540 kcal

•32 0z (large) soda: 400 kcal

TOTAL 1510 kcal

A 70 kg moderately active man requires 2100 kcal/day (3 meals).

Where Do Patients Fit In?Clinical Terms Used to Describe Various Levels of Body Fat

Normal Weight (BMI 18.5 to 24.9)

Overweight(BMI 25 to 29.9)

Obese(BMI 30 to 34.9)

Severely Obese(BMI 35 to 39.9 )

Morbidly Obese(BMI 40 or more)

Weight Loss at RRMC

•Medical

•Surgical

•Behavioral

Weight Loss Options (Moderately Overweight)Medical Treatment of Obesity

• Diet–low in calories, fat and carbohydrates

• Exercise–40 minutes 5 times per week

•

•Behavior Modification–eat 3 sensible meals per day, avoid snacking, meal

replacement

Two Options

Accelerated Weight Loss•The use of pre-packaged meal replacements

and supplements to achieve fast results.

Lean&Clean•A whole foods approach to weight loss and

lifelong health.

Where Do Patients Fit In?Clinical Terms Used to Describe Various Levels of Body Fat

Normal Weight (BMI 18.5 to 24.9)

Overweight(BMI 25 to 29.9)

Obese(BMI 30 to 34.9)

Severely Obese(BMI 35 to 39.9 )

Morbidly Obese(BMI 40 or more)

Challenge with Medical Therapy

Problems with Conservative WL in Morbidly Obese

• Most patients (95-97%) regain most or all of the weight that was lost within 1 year following diet or drug treatment

• The average amount of weight loss is relatively small -- 10-40 pounds

• Drug therapy may be associated with severe complications (Fen-Phen and heart disease)

Weight Loss Surgery

Average 55% loss of excess body

weight OVER LIFETIME

Surgery for morbid obesity? Why?

•Calories OUT must be > Calories IN

•Restrict

•Malabsorb

Most Common Surgical Options

Gastric Bypass (GBP) Band System

Restrictive and Malabsorptive

Restrictive and Adjustable

Sleeve Gastrectomy

Restrictive

Gastric Bypass (Roux-en-Y)(43644)

LAGB Procedure (43770)

Sleeve Gastrectomy (43775)

Bariatric Patients at RRMC

Preop Workup

•Information Session (Free, group or private)

•Initial Bariatric Consultation (Level 5 Visit)

•Labs and Imaging

•Forward to Insurance Carrier

Candidacy?• BMI criteria

– BMI is at least 40

– BMI is at least 35 and with combormidities

• Are at least 18 years old

• Understand surgery and the risks

• No uncontrolled psychological conditions

• Are prepared to attend regular follow-up sessions and make lifestyle changes

• Consensus of the bariatric team

Insurance

•Varies by insurance company

•Varies by patients choice of plan

•Many large corporations on Peninsula offer coverage

•Center employs coordinator/insurance specialist who will assist

Insurance Approval

• This is often the biggest delay!

•Requirements and lead time vary by company

•Sufficient documentation of medically supervised diet

Finance Programs

•Credit Lines through Riverside

RMWLC Requirements

•Helpful to have all paperwork regarding past weight loss attempts from PCP

•Initial questionnaire

Patient Flow- Inpatient

•To Operating Room

•Walking night of surgery

•Drinking day after surgery

•Home POD 2

•Back to work in less than two weeks

Possible Risks and Complications

Remember: There are risks associated with any surgery.

Categories LAP-BAND

Gastric Bypass

Sleeve Gastrectomy

Major Complications 0.2% 1.4% 1.4%

Mortality Rate 0.11% 0.5% 0.8%

Sources: Ren CJ, Laker S, Weiner M, Hajoseuedjavadi O, J Am Coll Surg, v 202, No 2, Feb 2006; ASERNIPS Executive Summary, 2002.

Mortality

Drug Eluding Stent4

Mortality Rate

Lap Cholecystectomy40.00

0.50

1.00

2.00

Rat

e (%

)

Appendectomy4

GI Obstru

ction4

CABG w/ cath4

Carotid Stent4

Hernia4

Flum1

DeMaria2

Buckwald3

HHS4

1.50

Comparing Weight-Loss Results

Source: O’Brien et al. Obesity is a Surgical Disease: Overview of Obesity and Bariatric Surgery, ANZ J Surg, 2004; 74: 200-204.

Gastric Bypass

LAP-BAND

% Medical Co-Morbidities Resolved after Bariatric Surgery

Type 2 Diabetes 95%

Hypertension 92%

Cardiac Function 95%

Osteoarthritis 82%

Sleep Apnea 75%

GERD 98%

Stress Incontinence 87%

Hypercholesterolemia 97%

Riverside Medical & Surgical Weight Loss Center

•Full service metabolic center, under one roof

•Choice of Medical or Surgical options

•Dietician, Exercise, Behavioral

•Access to diagnostics in same building

•Open, Active correspondence with referring provider

757-637-7637