Transcript Understanding the BioEnterics® LAP-BAND® System

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. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 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. Adults
BRFSS, 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
Change in the cost of living after
weight-loss surgery can be dramatic
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
TOTAL
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
$15,568
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
Rebound
Rebound
Rebound
Rebound
Rebound
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)
Restrictive and
Malabsorptive
Sleeve Gastrectomy
Restrictive
Band System
Restrictive and
Adjustable
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
LAPBAND
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
Mortality Rate
2.00
Rate (%)
1.50
1.00
0.50
0.00
Comparing Weight-Loss Results
Gastric Bypass
LAP-BAND
Source: O’Brien et al. Obesity is a Surgical Disease: Overview of Obesity and
Bariatric Surgery, ANZ J Surg, 2004; 74: 200-204.
% Medical Co-Morbidities Resolved after
Bariatric Surgery
Hypercholesterolemia
97%
Type 2 Diabetes
95%
Hypertension
92%
GERD
98%
Cardiac Function
95%
Stress Incontinence
87%
Osteoarthritis
82%
Sleep Apnea
75%
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