Obesity Symposium Advocate Good Samaritan Hospital Advocate Good Samaritan Hospital Speakers from Advocate Speakers from Advocate Attendance from hospitals and Medical Groups Attendance from hospitals and Medical Groups Attendance includes: Ancillary staff, Nurses and Physicians Attendance includes: Ancillary staff, Nurses and Physicians Goals for : Goals for : OBESITY AWARENESS OBESITY AWARENESS

CME/CEU disclosure of information Speakers Speakers Event Planners Event Planners

Causes of Weight Gain Genetics Genetics Intake of Calories Intake of Calories Absorption of calories Absorption of calories Calories burned Calories burned Calories IN –Calories OUT Calories IN –Calories OUT

Prevalence of Self-Reported Obesity Among U.S. Adults BRFSS, 2011 Source: Behavioral Risk Factor Surveillance System, CDC. Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to previous years. StatePrevalenceConfidence Interval Alabama32.0 (30.5, 33.5) Alaska27.4 (25.3, 29.7) Arizona24.7 (22.7, 26.9) Arkansas30.9 (28.8, 33.1) California23.8 (22.9, 24.7) Colorado20.7 (19.7, 21.8) Connecticut24.5 (23.0, 26.0) Delaware28.8 (26.9, 30.7) District of Columbia23.7 (21.9, 25.7) Florida26.6 (25.4, 27.9) Georgia28.0 (26.6, 29.4) Hawaii21.8 (20.4, 23.4) Idaho27.0 (25.3, 28.9) Illinois27.1 (25.4, 28.9) Indiana30.8 (29.5, 32.3) Iowa29.0 (27.6, 30.3) Kansas29.6 (28.7, 30.4) Kentucky30.4 (28.9, 31.9) Louisiana33.4 (32.0, 34.9) Maine27.8 (26.8, 28.9) Maryland28.3 (26.9, 29.7) Massachusetts22.7 (21.8, 23.7) Michigan 31.3 (30.0, 32.6) Minnesota 25.7 (24.6, 26.8) Mississippi 34.9 (33.5, 36.3) StatePrevalenceConfidence Interval Missouri30.3 (28.6, 32.0) Montana24.6 (23.3, 26.0) Nebraska28.4 (27.6, 29.2) Nevada24.5 (22.5, 26.6) New Hampshire26.2 (24.7, 27.7) New Jersey23.7 (22.7, 24.8) New Mexico26.3 (25.1, 27.6) New York24.5 (23.2, 25.9) North Carolina29.1 (27.7, 30.6) North Dakota27.8 (26.3, 29.4) Ohio29.6 (28.3, 31.0) Oklahoma31.1 (29.7, 32.5) Oregon26.7 (25.2, 28.3) Pennsylvania28.6 (27.3, 29.8) Rhode Island25.4 (23.9, 27.0) South Carolina30.8 (29.6, 32.1) South Dakota28.1 (26.3, 30.1) Tennessee29.2 (26.8, 31.7) Texas30.4 (29.1, 31.8) Utah24.4 (23.4, 25.5) Vermont25.4 (24.1, 26.8) Virginia29.2 (27.5, 30.9) Washington26.5 (25.3, 27.7) West Virginia32.4 (30.9, 34.0) Wisconsin27.7 (25.8, 29.7) Wyoming25.0 (23.5, 26.6)

2009 Age-Adjusted Estimates of the Percentage of Adults † with Diagnosed Diabetes in Illinois DuPage County 6.8% DeKalb County 7.9% Cook County 8.8% Kane County 8.1% Will County 8.6% CDC Diabetes data and trends

County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2009 Age-adjusted percent

Definition – Severe or Morbid Obesity 100 lb > Ideal body weight Body Mass Index (BMI) > 35 Height '10" '11" ' '1" '2" '3" '4" '5" '6" '7" '8" '9" '10" '11" '

The Current State of Bariatric Surgery l February 18, 2010 l Obesity is a Metabolic Disease Liver disease Gallbladder disease Osteoarthritis Gout Asthma Heart disease Menstrual/ Infertility problems Type 2 diabetes High blood pressure Sleep apnea GERD Increases your chance of developing one of these and/or additional diseasesIncreases your chance of developing one of these and/or additional diseases

The Current State of Bariatric Surgery l February 18, 2010 l Resolution or improvement of comorbiditiesResolution or improvement of comorbidities Only surgery has resulted in weight maintenance for the long-termOnly surgery has resulted in weight maintenance for the long-term Comorbidity Resolution After Bariatric Surgery

Obesity Treatment Guide Source: The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health. National Heart, Lung, and Blood Institute. October 2000, NIH Publication No Treatment >40 Diet, Exercise, Behavior Therapy With comorbid- ities +++ Pharmaco -therapy With comorbid- ities +++ Bariatric Surgery With comorbid- ities BMI Category (kg/m 2 )

Surgical Treatment For Morbid Obesity Lap-BAND ®, Gastric Bypass, and Gastric Sleeve

Overall Risk Non Surgical vs. Surgical Non Surgical Treatment Surgical Treatment

Normal Anatomy Stomach & Intestines *Picture provided by AllReferHealth.com

Surgical Treatment Morbid Obesity GASTRIC BYPASS Two weight loss components Two weight loss components Reduces the size of the stomachReduces the size of the stomach Reduces calorie absorptionReduces calorie absorption *Picture provided by AllReferHealth.com

Gastric Bypass

Surgical Treatment Morbid Obesity Lap-BAND ® One weight loss component One weight loss component Reduces the size of the stomachReduces the size of the stomach *Picture provided by AllReferHealth.com

Surgery Lap-BAND ®

Surgical Treatment Morbid Obesity SLEEVE GASTRECTOMY Procedure that removes 2/3’s of the stomach Procedure that removes 2/3’s of the stomach Restrictive only Restrictive only

Laparoscopic Gastric Sleeve Laparoscopic Gastric Sleeve

Duodenal Switch (DS) Start with Sleeve gastrectomy Start with Sleeve gastrectomy Perform long bypass Perform long bypass 2 components Partially restrictive and malabsorptive 2 components Partially restrictive and malabsorptive

DS

Gastric Bypass vs Lap-BAND ® vs Gastric Sleeve vs Duodenal Switch

Gastric Bypass vs BAND vs Sleeve vs DS G BYPASSBANDSLEEVEDS Cutting of stomach or intestines required? YesNoYes Average time in the hospital (days) Reversible? Not Practical YesNo Speed of excess weight loss FasterSlowerMedFastest Loss of excess weight Slightly More Slightly Less MiddleMost Loss of medical problems (co- morbidities) Slightly More Slightly Less MiddleMost

Gastric Bypass vs Sleeve vs BAND vs DS Gastric Bypass SleeveBAND DS Mortality rateLow LowerSl higher Serious complication 3% 1% < 1%7% Need to Take vitamins forever Yes YES Vitamin deficiencies More LESS LessMOST Protein deficiencies More LESS LessMOST