BARIATRIC SURGERY UT Health | McGovern Medical School UT Minimally Invasive Surgeons of Texas

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TOPICS TO DISCUSS What is Obesity? Do I qualify for weight loss surgery? Which surgery is right for me? What can I expect during the process?

Defining Obesity Obesity is an excessive accumulation of body fat. Many people believe that obesity is caused by simply overeating and a lack of self-control. But the truth is, it’s a chronic progressive disease that is caused by many factors.

Body Mass Index 5'4" Height Weight (lbs) 5'2" 5'0" 5'10" 5'8" 5'6" 6'0" 6'2" 120 130 150 160 170 180 190 200 210 220 230 240 250 140 260 270 280 290 300 6'4" A ratio of weight to height called Body mass index or BMI is generally used to classify the degree of overweight

CLASS III, SEVERE OBESITY NORMAL BMI 18.5 – 24.9 OVERWEIGHT BMI 25 – 29.9 CLASS I, OBESITY BMI 30 – 34.9 CLASS II, SERIOUS OBESITY BMI 35 – 39.9 CLASS III, SEVERE OBESITY BMI  40

Obesity is a multifactorial disease with a strong genetic component Genetics Hormonal Factors Cultural Factors Psychological Factors Behavioral Factors Metabolic Factors

Obesity-related Diseases Diabetes High blood pressure Heart disease Stroke High cholesterol Osteoarthritis and other orthopedic problems Cancer (esophagus, pancreas, colon, breast, endometrium, kidney, thyroid, and gallbladder) Infertility Sleep apnea Liver and gallbladder disease Etc. Obesity is associated with over 200 different disease and medical conditions.

Obesity is the 2nd leading cause of preventable death, followed behind smoking, in the United States. Obesity and obesity-related conditions together may lead to a lower quality of life, disability or early death.

Obesity is Treatable Even modest weight loss (5-15% of total body weight) reduces risk factors for certain diseases. Various effective treatments for obesity are available including diet and exercise, pharmaceuticals, endoluminal procedures, and surgery.

Bariatric Surgery Bariatric surgery is the most effective treatment for patients with obesity. Surgery reduces the risk of premature death by 30-40%.

Bariatric Surgery Bariatric surgery is safe. - Risk of mortality is 0.1%, which is lower than surgery to remove the gallbladder or getting a hip replaced Bariatric surgery is durable. - At 5 years after surgery, the majority of patients maintain at least 50% of their excess weight loss

Bariatric Surgery Qualifications BMI ≥ 40, or more than 100 pounds overweight BMI ≥35 and at least one or more obesity-related co-morbidities Type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non- alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

Bariatric Surgery Qualifications Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts. No significant physical, medical, emotional or psychological problems. Full understanding of risks associated with surgery. Participate in permanent lifestyle changes and long-term follow-up.

Bariatric Surgery is only a tool to help achieve a healthier lifestyle!

Long-term success is predicated on permanent diet, lifestyle, and exercise changes.

Surgical Options Types of procedures Restrictive Malabsorptive Metabolic Combination Procedures offered Adjustable Gastric Band Sleeve Gastrectomy Roux-en-Y Gastric Bypass Duodenal Switch Revisions & Reversals

Minimally Invasive/Laparoscopic Surgery Benefits are: Small incisions that heal with minimal scarring Less pain Shorter hospital stay Faster recovery Earlier return to work

Adjustable Gastric Band A silicone band is placed around the upper part of the stomach and induces a feeling of fullness Purely restrictive procedure, no metabolic effect Outpatient procedure with quick return to work Requires needle sticks to adjust band for gradual tightening every 6-8 weeks 40-50% excess weight loss at 2 years on average

Adjustable Gastric Band Advantages No stomach stapling or cutting, or intestinal rerouting Lowest operative complication, mortality rate, and malnutrition risk Adjustable and reversible Disadvantages Slippage or erosion causing injury to the esophagus or stomach Device malfunction and port site infection Slower weight loss Requires regular follow-up and several band adjustments a year for optimal results

50-70% excess weight loss at 18 months on average Sleeve Gastrectomy Performed since early 2000s 70-80% of stomach is removed completely leaving a long, tubular stomach Improved gut hormone regulation 50-70% excess weight loss at 18 months on average

Sleeve Gastrectomy Advantages No intestinal rerouting Can be changed to almost any other weight loss procedure if needed in the future Disadvantages Leaks, bleeding or stenosis related to staple line 15-20% experience heartburn Because the stomach is removed, it is not reversible

Roux-en-Y Gastric Bypass First done in 1967 Stomach is stapled to make a small pouch and rerouting the intestines reduce the amount you absorb Reflux, heartburn, and diabetes are profoundly improved Rapid weight loss: majority of weight loss occurs in first 6-8 months after surgery 60-80% excess weight loss at 12-18 months on average

Roux-en-Y Gastric Bypass Advantages Viewed as the gold standard in weight loss surgery Stomach not removed Rapid weight loss More rapid and predictable improvement in most co- morbidities, especially Type 2 diabetes Disadvantages Stomach and intestines divided and re-routed Risks for leak, bleeding, stricture, and internal hernia Dumping Syndrome is a possibility (inability to tolerate certain foods) High risk for ulcers in smokers and frequent NSAID use NO NSAIDs (Aspirin, ibuprofen or Motrin) and NO SMOKING!

Dumping Syndrome Up to 85% of patients will experience dumping syndrome Rapid heart rate, nausea, vomiting, abdominal pain, and diarrhea Occurs when eating foods high in sugar

80-90 % excess weight loss at 12 months on average Duodenal Switch Combines mechanisms of sleeve gastrectomy and gastric bypass Typically reserved for pts with BMI >50 and DM Good options for patients who have weight regain after sleeve 80-90 % excess weight loss at 12 months on average

Duodenal Switch Advantages Highest rate of weight loss Disadvantages Stomach and intestines divided and re-routed Risks for leak, bleeding, stricture, and internal hernia Dumping Syndrome is a possibility Frequent bowel movements (2- 6x/day) Significant malnutrition Must also take fat-soluble vitamins A,D,E,K NO NSAIDs (Aspirin, ibuprofen or Motrin) and NO SMOKING!

UT MIST offers comprehensive care through all stages of weight loss - from pre-operative treatment to post-surgical strategies for maintaining health.

Large Clinical Support Team All MIST surgeons are fellowship trained Perform all accepted procedures Experienced surgeons Large team of Nurses, Fellows, Residents Multiple people focused on your care Large Clinical Support Team Full team of personnel for pre- and post-op support Education, Nutrition, Psychology, Support Groups Comprehensive program Robotics, Flexible Endoscopy, New Product Releases and Research Cutting edge surgeries with published results State-of-the art technology

Insurance Coverage There are many different levels of coverage for weight-loss surgery. We have dedicated staff to help you navigate your insurance policy and determine what your specific policy covers. Medically supervised weight loss (MSWL) prior to surgery is common.

We are committed to providing comprehensive, compassionate care and want to help you achieve a healthier and happier life.

Minimally Invasive Surgeons of Texas UTMIST Minimally Invasive Surgeons of Texas Telephone: 713-892-5500 Website: www.UTMIST.com