Post on 07-May-2015
description
Bariatrics & Beyond
Elizabeth A. Warner, MDGeneral & Bariatric Surgery
www.SpringfieldClinic.com/DoctorIsIn
Outline• What is Obesity? (Calculate your BMI)
• Obesity Trends in U.S.
• Obesity Comorbidities
• Cause of Obesity
• Bariatric Surgery Options and Benefits
• Candidates for Bariatric Surgery
• Bariatric Surgery Program Components
What is Obesity?• Body Mass Index (BMI) = • Weight Categories:
• Underweight- BMI <18.5• Normal weight- BMI ≥18.5-24.9• Overweight- BMI 25-29.9• Obese- BMI ≥30
• Class I- BMI 30-34.9• Class II- BMI 35-39.9• Class III- BMI ≥40
• Super obese- BMI >50
Weight (kg)Height (m)2
BMI Real Life Example
5’4”
120lbs: BMI 20.6
140lbs: BMI 24 160lbs: BMI 27.4
180lbs: BMI 30.9 200lbs: BMI 34.3
220lbs: BMI 37.7 240lbs: BMI 41.1
260lbs: BMI 44.6
280lbs: BMI 48
5’9½”
120lbs: BMI 17.4
140lbs: BMI 20.4
160lbs: BMI 23.3
180lbs: BMI 26.2
200lbs: BMI 29.1
220lbs: BMI 32
240lbs: BMI 34.9
260lbs: BMI 37.8
280lbs: BMI 40.7
Underweight <18.5Normal weight ≥18.5-24.9Overweight 25-29.9Obese- ≥30
Class I- 30-34.9Class II- 35-39.9Class III- ≥40
Super obese- >50
Obesity Trends Among U.S. Adults
1985
http://www.cdc.gov/obesity/data/adult.html
Obesity Trends Among U.S. Adults
1990
http://www.cdc.gov/obesity/data/adult.html
Obesity Trends Among U.S. Adults
1995
http://www.cdc.gov/obesity/data/adult.html
Obesity Trends Among U.S. Adults
2000
http://www.cdc.gov/obesity/data/adult.html
Obesity Trends Among U.S. Adults
2005
http://www.cdc.gov/obesity/data/adult.html
Obesity Trends Among U.S. Adults
2010
http://www.cdc.gov/obesity/data/adult.html
Why do physicians care about obesity? • Hypertension• Diabetes• Coronary artery disease• Heart failure• Atrial fibrillation• Kidney disease• Obstructive sleep apnea• Osteoarthritis• Cholelithiasis• Infection• GERD• PCOS, Infertility
• Sexual dysfunction• Urinary incontinence• Hepatic steatosis (“fatty liver”)• Stroke• Cancer: Esophagus, stomach,
colon, rectum, liver, gallbladder, pancreas, kidney, breast, prostate, uterus, cervix, ovarian, lymphoma, multiple myeloma
• Death (all-cause and cardiac)
What causes obesity?
• Calories In• Calories Out• Metabolism
• Muscle mass• Genetics• Microbiome• Stress• Sleep
Calories In (Eating)
• Hyperpalatable foods
• Salt-Sugar-Fat
• Bliss point
• Standard American Diet (S.A.D.)
• Convenient, Low cost
• Highly processed
• Devoid of micronutrients and fiber
Sugar4g of sugar = 1 tsp of sugar
12oz coke: 38.5g of sugar8oz grape juice: 40g of sugar8oz apple juice: 28g of sugar8oz orange juice: 26g of sugar
Calories Out (Activity)• Calorie Expenditure
• Aerobics (low impact) 272kcal
• Bicycling (10mph) 327kcal
• Bowling 163kcal
• Housework 163kcal
• Jogging (6mph) 544kcal
• Stair climbing 435kcal
• Vacuuming 191kcal
• Walking (3mph) 180kcal
• Washing the car 163kcal
• Sleeping 49kcal
• Watching television 54kcal
• Driving 109kcal
• Standing 65kcal
• Grocery shopping 125kcal
www.caloriesperhour.com
Prevention Is Key
• Establish healthy eating habits early for children
• The majority of meals should be made at home
• Be mindful of gradual weight gain and make adjustments before the problem feels overwhelming
– Once a week weigh in
– Clamp down on diet and increase activity
• Consistency (diet & exercise) is mandatory
Dr. Warner’s Quick Tips• No soda or juice (Liquid calories = NEVER foods)
• Increase your fruit & vegetable consumption
• Decrease your processed food consumption
• Eat at least one green thing per day
• Keep a food journal
• Start to read labels and educate yourself
• Get the ‘bad for you food’ out of the house
Bariatric Surgery Options
Gastric Bypass Sleeve Gastrectomy Gastric Band
Bariatric Surgery Benefits• Rapid weight loss
– 70% EBW Gastric Bypass (~1 year)
– 60% EBW Sleeve Gastrectomy (~1 year)
– 50% EBW Gastric Band (~2 years)
• Improvement in comorbidities
– Diabetes
– Hypertension
– Obstructive Sleep Apnea
– GERD
– Infertility
MMC Bariatric Surgery Benefits at 5 Years
Bariatric Surgery- Who is a candidate?
• Body Mass Index (BMI) = • Weight Categories:
• Underweight- BMI <18.5• Normal weight- BMI ≥18.5-24.9• Overweight- BMI 25-29.9• Obese- BMI ≥30
• Class I- BMI 30-34.9• Class II- BMI 35-39.9• Class III- BMI ≥40
• Super obese- BMI >50
Weight (kg)Height (m)2
Memorial Bariatric Surgery Program• Springfield Clinic partnership with Memorial Hospital• Multidisciplinary Program:
• Medical evaluation and education• Medical candidacy• Procedure choice
• Nutritional evaluation and education• Physical therapy evaluation and education
• Fitness assessment• Personalized exercise program
• Psychological evaluation and support• Monthly support groups• Long-term follow-up
More Information
www.MemorialBariatricServices.com
www.SpringfieldClinic.com