1. KYLE PRESCOTT EXS 486 Bariatric Surgery

2. Bariatrics? Bari/baro- weight or pressure Iatr- treatment Ic- pertaining to Bariatrics- treatments pertaining to weight or pressure (obesity)

3. Obesity Approximately 66% of US adults are overweight or obese The Gynoid (pear shaped) is recommended over the Android (apple shaped) in terms of fat distribution as visceral fat covers the abdominal region and may effect major organs in that area. Obesity stratification-  Class 1 obesity: Bmi 30-34.9  Class 2 obesity: Bmi 35-39.9  Class 3 obesity: Bmi 40+

4. Who needs this surgery Should be used only in the most severe cases Used for patients with a 40+ Bmi rating or 35+ score with another comorbidity as well. The FDA has approved the use of an adjustable gastric band for patients with a Bmi of 30+ and also have a comorbidity such as heart disease or diabetes

5. Different types Several types of surgeries ranking from minimally to quite invasive. Laparoscopic vs. open surgery  Laparoscopic- minimally invasive, creates small incisions in the body and then uses a series of instruments connected to a camera that sends images to a screen so surgery can be done less invasively.  Open- standard approach where the stomach is cut open and the surgery is done. (may be the only option for certain patients: extremely obese, previous stomach surgeries etc.)

6. Types cont. Four types of surgeries that are done here in the United States. Adjustable Gastric Band Roux en Y Gastric bypass Gastric Sleeve Biliopancreatic Diversion with a Duodenal switch

7. Adjustable Gastric Band (AGB) Laparoscopic (least invasive) A small band is placed on the top of the stomach to help control the size of the opening from esophagus to stomach. It is restrictive as a balloon is placed inside the band that controls the size of the band and how much food will be restricted.

8. Roux en Y Gastric Bypass (RYGB) Similar to the lapband surgery before as a small opening is left at the top of the stomach. Different because after this pouch food now “bypasses” the rest of the stomach and goes directly to the small intestine to go through the digestion process.

9. Gastric Sleeve In this surgery most of the stomach is removed leaving the small upper portion of the stomach for digestive purposes.

10. Biliopancreatic Diversion with a Duodenal switch Most invasive Very similar to the Gastric sleeve a very large portion of the stomach is removed leaving the small “sleeve like pouch” The next step goes on to bypass the majority of the small intestine only connecting to the last quarter for absorption and digestive purposes

11. Pros/cons Pros:  Restricts food intake  Elicits significant weight loss  May help to in beating other comorbidities  Helps in suppressing appetite and hunger  May help a person change life around and increase energy expenditure  Cons  Increase in nutrient and vitamin deficiencies  May not ever get back to “normal eating”  Surgery complications  Possibility of not reaching weight loss goals  Reversibility

12. Case Study 56 year old male Sedentary individual has a desk job Mother died of heart attack at age 60 69 inches, 315 lbs 46.5 Bmi measurement Comorbidities include hypertension and type 2 diabetes Risk stratification:  This is a very high risk individual  Due to age  Symptomatic  Sedentary  High Bmi measurement  Known comorbidities such as hypertension and Diabetes

13. Recommendations Based on the clients feeling about the different types of surgeries I have two suggestions If the client has qualms when it comes to open surgeries I would recommend the laparoscopic gastric bypass surgery which is less invasive Due to the severity of his case I would recommend getting a gastric sleeve which is quite invasive but isn't the worst of them all and is a little better when it comes to after surgery complications when it comes to malabsorption compared to the Duodenal switch

14. Exercise Testing Post surgery* Physician cleared If successful the surgery should help do away with comorbidities associated with this individual Individual is now in a weight loss maintenance phase Assess cardiovascular fitness on treadmill or cycle ergometer

15. Exercise prescription Lifestyle change, goal setting in terms of daily eating/exercise Main goal post surgery is weight maintenance/prevention of weight regain Gradually increase to 250+ mins week of moderate to vigorous intensity exercise (40-60+% VO2R) Because individual was previously sedentary non weight bearing exercises should be beneficial to start.

16. Prescription cont. F- 5+ days a week I- moderate to vigorous exercise intensity (40-60% VO2R) focused on aerobics. Gradually increase to intensities over 60% T- start off at about 30 mins daily and work way up to 60 mins of daily exercise. For starters exercise doesn’t have to be all at once can be broken up into 10 min increments T- Aerobic activities that incorporate large muscle groups. (walking, jogging, cycling, sports etc.)

17. Summary Overall goal for this population is to keep weight off post surgery. By incorporating healthy eating habits and beginning some type of exercise program this can be achieved. With this surgery and a few major lifestyle changes this client will be able to reach his goal of long term weight loss and maintenance.

18. References 1. Bariatric Surgery Procedures - ASMBS. (2016). Retrieved January 4, 2016, from https://asmbs.org/patients/bariatric-surgery-procedures https://asmbs.org/patients/bariatric-surgery-procedures 2. 1 Inge TH‚ Krebs NF‚ Garcia VF‚ et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004 Jul;114(1):217–23.2. 2 Wilson ST‚ Thomas HI‚ Randall SB. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Archives of Pediatrics & Adolescent Medicine. 2007;161(3):217–221 3. Is Weight Loss Surgery for You? (2014). Retrieved January 4, 2016, from http://www.webmd.com/diet/obesity/surgery-for-you http://www.webmd.com/diet/obesity/surgery-for-you 4. Pescatello, Linda S. (2014). Acsm's Guideline for Exercise Testing and Prescription. Baltimore: American College of Sports Medicine. 5. Reed, Melissa A. (2016) Overweight and obesity [Powerpoint slides]. Retrieved from https://d2l.wcupa.edu/d2l/le/content/1972008/viewContent/11357455/View https://d2l.wcupa.edu/d2l/le/content/1972008/viewContent/11357455/View