1. Nutritional Counseling Unit 5 Leslie Young MS,RD,LDN Kaplan University Instructor

2. Counseling

3. Background on weight loss surgeries Lap-Band- non invasive Traditional gastric bypass Pictures taken from www.lapband.com

4. comparisons LAP-BAND ® SystemDiet and Exercise Support In addition to support from the experts at your doctor’s office, you’ll get practical tracking tools, recipes, articles, and advice available exclusively through My LAP- BAND ® Journey, an online clinical support program Freedom to choose the type of foods and exercise you like. Unfortunately, self- imposed diet and exercise don’t always come with expert support or practical tools for sustaining weight loss

5. results Lap Band surgery regular diet/exercise Although weight loss of up to three pounds a week is possible, LAP-BAND ® System patients average a healthy one-to-two pound reduction a week. 8 Best of all, once patients meet their target weight, they often maintain it for years. In fact, according to a clinical study (N=100), LAP-BAND ® System patients averaged up to a 59% reduction in excess weight after eight years 9* *The LAP-BAND ® System was approved in the United States on the basis of a nonrandomized, single-arm study (N=299). Significant improvement in percent of excess weight loss vs. baseline was achieved at 12 months (34.5%), 24 months (37.8%), and 36 months (36.2%). The mean reduction in BMI was 8.5 at 12 months, 9.4 at 24 months and 8.8 at 36 months. 1 And for those with a Body Mass Index (BMI) between 30 and 40, a new study (N=149) shows that the LAP-BAND® System provides significant results. 10 In the first 12 months (N=143): The mean Excess Weight Loss (EWL) was 64.5% The mean reduction in Body Mass Index(BMI) was 6.5 points The mean reduction in waist circumference(in inches) for men was 6.1 inches; women 5.9 inches Weight loss was maintained at year 2 Unfortunately, diet, fitness, and medication to treat obesity offer only short-term results. Studies show that obese patients on diets, exercise programs, or weight loss medications lose approximately 10% of their body weight, but tend to regain two-thirds within one year — and most of the weight within five years 3 Adapted from: http://www.lapband.com/en/learn_ab out_lapband/compare_lapband/

6. Case Study #1- Lap Band Surgery J.T. is a 39 year old male who is coming to visit you because he is obese and has high cholesterol. The doctor’s office called prior to his visit to let you know he is interested in lap band surgery and in order for his insurance to agree to pay for the surgery; he needs to see you once a month for 12 months. The doctor’s office sent a current height of 6’2” and a weight of 395 lbs; however this was a stated weight because their scale only goes up to 350 lbs. But in your office the scale weighs up to 500 lbs. The doctor’s office also tells you he is currently drinking a high protein shake twice a day. J.T. comes in to see you. Labs: Fasting Glucose 105, Total Cholesterol 260 mg/dL, LDL 145 mg/dL, HDL 28 mg/dL, Triglycerides 450 mg/dL Meds: Tricor, Lasix What is the first thing you would do? What is his BMI? What do his labs mean to you? What stage of change is he in? What information would you collect from him? What education would you provide to him- how many calories would you give him? What other nutrient information would you provide him with? What goals would you establish with him?

7. Case Study #2- Follow up Weight Management R.M. is a 40 year old female that has seen you last month and is now coming in for a follow up appointment. She is trying to lose weight, but has not lost anything within the past month and in fact has gained 5 pounds. The first time you had seen her, she was only eating 1 meal per day and drinking 3-20oz bottles of Mountain Dew per day, snacked on chocolate kisses and was not a fan of fruits or vegetables, but could try to drink V8 and 100% fruit juice. She was unable to exercise because of her severe arthritis and back pain. The last time you had seen her, you had both discussed a 1600 calorie diet that broke down to 50% of total carbohydrates, 25% of total fat and 25% of total protein. The goals you had established at that time was for her to eat 3 meals at consistent times and find out if there was a water aerobics class at the local pool. Her height measured at 5’2” and her weight the first visit was 180 pounds and is currently 185 pounds. 1. What is her current BMI? Is her weight gain severe or not? 2. What is her stage of change? 3. What type of information would you provide her with? 4. What type of goals would you establish with her? 5. When would you follow up with her?

8. ADA- Empowering the Client http://www.facilitatingbehaviorchange.org/Chapter-Page.aspx?ChapterPage.SectionID=228 We are going to review a slide presentation on how we can change a scenario with a client. After reviewing the slide let’s discuss what we will do.