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Day 10: Weight Management/ Surgical and Non-Surgical

Facts about Weight Management

• More than one third (35) of adults in the united States are morbidly obese.
• Obesity is a contributing cause of many health problems, including heart disease, stroke, diabetes and some types of cancer. These are some of the leading causes of death in the United States.
• Obesity can cause sleep apnea and breathing problems and make activity more difficult. Obesity can also cause problems during pregnancy or make it more diffficult for a woman to become pregnant.
• Bariatric surgery may be a weight loss option for men and women who are at least 100 pounds overweight, suffer from related health conditions and have unsuccessfully tried other weight loss methods.

Non Surgical Weight Management
Developing your own balance of smart eating, attitude and activity is key to successful weight loss and management. The Harper BMI non-surgical weight management program combines nutrition, behavior and fitness assessments to develop individualized plans that will help you achieve weight loss success.

Nutritional Counseling
The DMC registered dieticians will provide nutrition education on an individualized level. Programs can be structured for those whose insurance provider requires a medically supervised diet before surgical authorizations, your plateaued weight loss that needs a jump start, "back on track" program or simply in preparation for a special occasion.
Whether you are interested in a single visit or 12 week program, we include a body composition analysis. A body composition analysis determines the amount of fat vs. lean muscle tissue in your body. Body weight alone does not indicate good health because it does not distinguish how many pounds are from fat, as well as where that fat is distributed.

The 12 week program includes:

  • Registration
  • Weekly dietician visit
  • Body Composition Analysis
  • Weigh-in and blood pressure check
  • Reviewing periodic lab tests
  • Participate in support groups
  • You'll learn how to eat more healthy, read nutrition labels and incorporate a healthy eating plan into your busy lifestyle.

Surgical Weight-Loss Options
Gastric Bypass
gastric bypass is the most frequently performed weight loss operation in the United States and is considered to be the current gold standard procedure for weight loss surgery according to the American Society for Bariatric and Metabolic Surgery and the National Institutes of Health.
The Roux-en-Y gastric bypass is a combined “restrictive” and “malabsorptive” weight loss operation. The stomach is divided creating a pouch approximately the size of a Dixie cup. This is the “restrictive” component, that is, the size of the stomach has been dramatically reduced restricting the amount of food that it can hold at any one time. The remainder of the stomach is not removed, but is completely divided from the stomach pouch.
The bypass segment of the procedure accounts for the “malabsorption”. The term, “malabsorption,” refers to the intestines inability to absorb all the ingested nutrients and calories. This is done by dividing the small bowel just beyond the the first 3 to 4 feet of small intestine and bringing it up to the pouch to create a new connection. The other end of the bowel is sewn back into the side of 4 to 5 feet of small intestine called the Roux limb.
Ingested food moves from the stomach pouch directly into the Roux limb. Enzymes (natural chemicals needed for digestion) travel through the biliopancreatic limb or “Y limb”. Food and enzymes meet and mix in the segment of small intestine referred to as the “common channel”. It is in the common channel that ingested nutrients and calories can be absorbed. In other words, after the bypass, patients will have one half to one third the length of their small intestine to absorb the food that they eat.

The result is an early sense of fullness, combined with a limited ability to absorb all calories that have been ingested. In general, patients have a reduction in appetite, diminished food cravings and an increase in their energy level.

The LAP-BAND® is a restrictive operation used for weight loss. The LAP-BAND® is made of silicone and is placed around the stomach near the upper end, creating a small upper pouch and a narrow passage into the larger lower portion of the stomach. The effect of the inflatable band is to trick your body’s hunger drive into thinking that you are full.

The LAP-BAND® has an adjustable inner-collar that can be inflated or deflated depending on a number of factors. The lap band is connected through a tube to a port (reservoir), which is placed under the skin of the upper abdomen. The collar around the stomach outlet is adjusted by adding or removing small amounts of saline solution by inserting a needle into the injection port in the doctor’s office. The adjustment is performed in the physician’s office. This technique leaves the digestive tract in the normal sequence for digestion and absorption. The only intended effect is a reduction in capacity for a meal. Small pouch volume and correct outlet diameter are very important for the success of this operation.

Gastric Sleeve
The Vertical Sleeve Gastrectomy is only performed by a limited number of surgeons worldwide, and 2-3 of those surgeons are at DMC Harper University Hospital. It is an operation in which the left side of the stomach is surgically removed, resulting in a new stomach which is roughly the size and shape of a banana. Since this operation does not require any “rerouting” or reconnecting the intestines, it is a simpler operation than the gastric bypass and unlike the lap band procedure, the sleeve gastrectomy does not require the implantation of an artificial device inside the abdomen.

Certain individuals with a lower BMI that are considering weight loss surgery may want to consider the Sleeve Gastrectomy because:

  • They are concerned about the potential long term side effects of an intestinal bypass.
  • They are considering a gastric band (Lap-Band® or REALIZE Banding Solution) but are concerned about a foreign body in their abdomen or frequent adjustments to the band.
  • They have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, severe asthma requiring frequent steroid use and other complex medical conditions.
  • They need to take anti-inflammatory medications.
  • For some patients, such as those with a body mass index greater than 60, the sleeve gastrectomy may be the first part of a 2 stage operation.

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 Michael Wood, M.D.
DMC Harper University Hospital

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