Bariatrics & Beyond

Elizabeth A. Warner, MDGeneral & Bariatric Surgery

www.SpringfieldClinic.com/DoctorIsIn

Outline• What is Obesity? (Calculate your BMI)

• Obesity Trends in U.S.

• Obesity Comorbidities

• Cause of Obesity

• Bariatric Surgery Options and Benefits

• Candidates for Bariatric Surgery

• Bariatric Surgery Program Components

What is Obesity?• Body Mass Index (BMI) = • Weight Categories:

• Underweight- BMI <18.5• Normal weight- BMI ≥18.5-24.9• Overweight- BMI 25-29.9• Obese- BMI ≥30

• Class I- BMI 30-34.9• Class II- BMI 35-39.9• Class III- BMI ≥40

• Super obese- BMI >50

Weight (kg)Height (m)2

BMI Real Life Example

5’4”

120lbs: BMI 20.6

140lbs: BMI 24 160lbs: BMI 27.4

180lbs: BMI 30.9 200lbs: BMI 34.3

220lbs: BMI 37.7 240lbs: BMI 41.1

260lbs: BMI 44.6

280lbs: BMI 48

5’9½”

120lbs: BMI 17.4

140lbs: BMI 20.4

160lbs: BMI 23.3

180lbs: BMI 26.2

200lbs: BMI 29.1

220lbs: BMI 32

240lbs: BMI 34.9

260lbs: BMI 37.8

280lbs: BMI 40.7

Underweight <18.5Normal weight ≥18.5-24.9Overweight 25-29.9Obese- ≥30

Class I- 30-34.9Class II- 35-39.9Class III- ≥40

Super obese- >50

Obesity Trends Among U.S. Adults

1985

http://www.cdc.gov/obesity/data/adult.html

Obesity Trends Among U.S. Adults

1990

http://www.cdc.gov/obesity/data/adult.html

Obesity Trends Among U.S. Adults

1995

http://www.cdc.gov/obesity/data/adult.html

Obesity Trends Among U.S. Adults

2000

http://www.cdc.gov/obesity/data/adult.html

Obesity Trends Among U.S. Adults

2005

http://www.cdc.gov/obesity/data/adult.html

Obesity Trends Among U.S. Adults

2010

http://www.cdc.gov/obesity/data/adult.html

Why do physicians care about obesity? • Hypertension• Diabetes• Coronary artery disease• Heart failure• Atrial fibrillation• Kidney disease• Obstructive sleep apnea• Osteoarthritis• Cholelithiasis• Infection• GERD• PCOS, Infertility

• Sexual dysfunction• Urinary incontinence• Hepatic steatosis (“fatty liver”)• Stroke• Cancer: Esophagus, stomach,

colon, rectum, liver, gallbladder, pancreas, kidney, breast, prostate, uterus, cervix, ovarian, lymphoma, multiple myeloma

• Death (all-cause and cardiac)

What causes obesity?

• Calories In• Calories Out• Metabolism

• Muscle mass• Genetics• Microbiome• Stress• Sleep

Calories In (Eating)

• Hyperpalatable foods

• Salt-Sugar-Fat

• Bliss point

• Standard American Diet (S.A.D.)

• Convenient, Low cost

• Highly processed

• Devoid of micronutrients and fiber

Sugar4g of sugar = 1 tsp of sugar

12oz coke: 38.5g of sugar8oz grape juice: 40g of sugar8oz apple juice: 28g of sugar8oz orange juice: 26g of sugar

Calories Out (Activity)• Calorie Expenditure

• Aerobics (low impact) 272kcal

• Bicycling (10mph) 327kcal

• Bowling 163kcal

• Housework 163kcal

• Jogging (6mph) 544kcal

• Stair climbing 435kcal

• Vacuuming 191kcal

• Walking (3mph) 180kcal

• Washing the car 163kcal

• Sleeping 49kcal

• Watching television 54kcal

• Driving 109kcal

• Standing 65kcal

• Grocery shopping 125kcal

www.caloriesperhour.com

Prevention Is Key

• Establish healthy eating habits early for children

• The majority of meals should be made at home

• Be mindful of gradual weight gain and make adjustments before the problem feels overwhelming

– Once a week weigh in

– Clamp down on diet and increase activity

• Consistency (diet & exercise) is mandatory

Dr. Warner’s Quick Tips• No soda or juice (Liquid calories = NEVER foods)

• Increase your fruit & vegetable consumption

• Decrease your processed food consumption

• Eat at least one green thing per day

• Keep a food journal

• Start to read labels and educate yourself

• Get the ‘bad for you food’ out of the house

Bariatric Surgery Options

Gastric Bypass Sleeve Gastrectomy Gastric Band

Bariatric Surgery Benefits• Rapid weight loss

– 70% EBW Gastric Bypass (~1 year)

– 60% EBW Sleeve Gastrectomy (~1 year)

– 50% EBW Gastric Band (~2 years)

• Improvement in comorbidities

– Diabetes

– Hypertension

– Obstructive Sleep Apnea

– GERD

– Infertility

MMC Bariatric Surgery Benefits at 5 Years

Bariatric Surgery- Who is a candidate?

• Body Mass Index (BMI) = • Weight Categories:

• Underweight- BMI <18.5• Normal weight- BMI ≥18.5-24.9• Overweight- BMI 25-29.9• Obese- BMI ≥30

• Class I- BMI 30-34.9• Class II- BMI 35-39.9• Class III- BMI ≥40

• Super obese- BMI >50

Weight (kg)Height (m)2

Memorial Bariatric Surgery Program• Springfield Clinic partnership with Memorial Hospital• Multidisciplinary Program:

• Medical evaluation and education• Medical candidacy• Procedure choice

• Nutritional evaluation and education• Physical therapy evaluation and education

• Fitness assessment• Personalized exercise program

• Psychological evaluation and support• Monthly support groups• Long-term follow-up

More Information

www.MemorialBariatricServices.com

www.SpringfieldClinic.com