Duke Weight Loss Seminar

By: Duke Health

This online seminar will provide you with an overview about the weight loss surgery options available at Duke. Choosing weight loss surgery is a big decision. The information presented here will help you learn about the various types of surgical procedures we offer as well as what to expect so that you can better assess if weight loss surgery is the right choice for you. This presentation will cover severe obesity, surgical treatment for obesity, potential health benefits of surgery, the outcomes that can be expected from this treatment, and details about the Duke program which is offered at two hospitals, Duke Regional Hospital and Duke Raleigh Hospital. The definition of obesity is based on body mass index or BMI. BMI determines what you should weigh based on your height. The taller you are, the more you should weigh.

You can find the formula on our website, dukewls.org. A good way I've found is that BMI over 40, means a person is about 100 lbs over their ideal weight. People who would consider weight loss surgery will have a BMI of 35 or more. What causes obesity? Genetics plays a part, as do behavior and environment. The role our environment and lifestyle plays in weight management issues cannot be overstated.

Consider the change in serving sizes over the years. 20 years ago, the average bagel was about 140 calories. Today, a standard bagel can be 350 calories. Pasta servings were once about 500 calories. Today, it is more than double. Sandwiches have grown significantly as well. Americans today are more likely to eat out at restaurants than they were 20 years ago. We have access to food nearly 24 hours per day in many cities.

Combine the accessibility of ready made meals with the work places that have become more sedentary and you can see the problem. We are eating more food and expending fewer calories and the result is more people who are struggling with weight problems and associated concerns such as diabetes. The risks of severe obesity include premature death, medical complications and problems with everyday life, such as mobility issues. Economic and emotional concerns can also be consequences. Severe obesity affects nearly every organ system in the body.

Duke Weight Loss Seminar

The medical complications associated with obesity include sleep apnea, liver disease, infertility, osteoarthritis, stroke, heart disease, diabetes and cancer. There are certain illnesses that we see often in our severely obese patients. We see type two diabetes in about a quarter of our patients, high blood pressure in over half our patients, high cholesterol in over 60% of our patients, and shortness of breath in nearly all of our patients. In addition to the impact on health, obesity can lead to low self-esteem, depression, and often discrimination. In fact, obesity has been called the last socially acceptable form of prejudice in our society. Some of the non surgical means to losing weight include diet, exercise and medication. Some people even try psychological counseling. You have no doubt tried a few of these approaches yourself.

All of these weight loss approaches can work, at least temporarily. We surveyed more than 1,600 applicants to our program about their results with various diet programs. They have been able to lose weight, over 240,000 pounds. The problem is that each of these individuals gain their weight back and even more, over 300,000 pounds. So as you've probably discovered, the problem is often not losing weight, but successfully keeping it off over the long term. Who is the good candidate for surgery? Someone with a body mass index of more than 40 or with a BMI between 35 and 40, with one significant medical problem related to obesity, would be considered a candidate for surgery. In 2011, the Food and Drug Administration lowered the BMI requirement for adjustable gastric banding to between 30 and 34.9, with at least one significant medical problem.

Some insurance companies require patients who would like weight loss surgery to demonstrate that past diets have not worked for them. On a practical level, there are many reasons someone might choose weight loss surgery. They may want to reduce their dependence upon medications, improve their overall health, or to generally have more energy for activities of daily living. They may have a desired weight or size in mind. They may want to lose weight so that they can live long enough to see their grandchildren grow up or they may just want to feel better about themselves.

Weight loss surgery is divided into two major classes, restrictive and combined mode of action. Restrictive surgery makes your stomach effectively smaller and limits how much you can eat. Combined mode of action is a combination of restrictive surgery and malabsorption which reroutes the digestive tract to bypass part of the intestines and lessen the amount of calories absorbed by the body. The adjustable gastric band is a restrictive procedure. There is no cutting or stapling in gastric banding. The lap band works by putting a device around the top part of the stomach like a belt. When you eat, the top part of the stomach above the belt stretches, making you feel full sooner. A tube connects to a small port under your skin, on your abdomen and food put in that tube inflates the lining on the belt, making it tighter or looser.

Gastric banding results in slower and less weight loss than other procedures and requires frequent clinic visits for band adjustments. This graphic shows how the band is filled. The port is placed underneath your skin on top of your abdominal wall.

When you come in to the clinic, we use a needle to put fluid in to the port to adjust the band so that it is not too tight and not too loose. Another restrictive procedure we offer is called the Sleeve Gastrectomy. Sleeve Gastrectomy reduces stomach capacity by removal of a portion of the stomach. The benefit of the Sleeve Gastrectomy is that there is no foreign body in your abdomen.

It is a permanent procedure. Of all the weight loss procedures today, Roux-en-Y Gastric Bypass has been around the longest. It is a more invasive surgery which results in faster and more weight loss than the other procedures covered so far.

A small pouch is created in the upper part of the stomach by stapling. The rest of the stomach continues to receive a blood supply. A piece of the intestine called the Roux-en-Y is reattached to the small pouch.

Food comes down through the Roux-en-Y bypassing the stomach. The duodenal switch is a more complex procedure that combines Ssleeve Gastrectomy with a malabsorptabive bypass. It leads to the most weight loss, but is the highest risk procedure. Most of our patients are treated with a B vitamin, calcium, and a multivitamin with iron, to prevent nutritional deficiencies. We also monitor our patients very closely to make sure they stay healthy. There are three types of incisions that can be used for weight loss surgery. We no longer use the traditional long incision. We specialize in minimally invasive surgery and most often, use a laparoscopic or single port access technique.

Minimally invasive surgery offers fewer wound complications and a better cosmetic result. Our center does offer robotic surgery. While there are no specific advantages of robotic surgery over minimally invasive surgery, we can accommodate patients interested in robotic surgery. As you can see, there are many types of weight loss surgery options. We can help you choose the procedure that is right for you. You will want to consider factors like your age, lifestyle and current health issues. Think about your main reason for wanting this surgery.

What types of improvements are you hoping for? How much weight do you want to lose? Do you have an adequate support system to help you not only recover, but also support what will be a different lifestyle than you have previously led? All of these considerations will factor into your decision. Weight loss surgery is not just about the procedure, the after care is very important. To ensure long-term success, your follow-up care includes regular visits with the surgeon, nutritionist, and psychologist. These are very important, as are your compliance with diet and exercise recommendations and the support of friends and family. Typically, patients will meet with their surgeon three weeks, three months, six months, and one year after surgery and at least once a year after that. We ask that our patients participate in group sessions three weeks, three months, six months and one year after surgery and then at least yearly.

Group sessions include small groups of people who have recently had a weight loss surgery. It is a good way to share concerns in a supportive environment with others who can relate to your life change. Every follow up visit is a reminder on the life changing commitment you have made. This commitment does not end after the honeymoon period of initial weight loss. Diet and exercise will remain very important to your weight loss success for the rest of your life. Surgery is only the beginning of a life long journey that will help you become a healthier, new you. The Duke program has extensive experience. We have performed more than 6,000 bariatric procedures.

We currently perform more than 750 a year. Since 2005, nearly all of our surgeries with the exception of revisions, have been performed laparoscopically. We measure weight loss in terms of percent of excess weight loss, not necessarily in pounds. A person who is 200 pounds overweight can expect to lose more pounds than someone who is only 100 pounds overweight. Expected weight loss varies with each of the procedures we offer. Expected weight loss over time with the band is between 30 and 40% of excess weight loss, with the sleeve gastroctomy, between 40 and 55%, with bypass, between 55 and 65% and with duodenal switch, between 60 and 80% of excess weight.

As with any surgery, there are risks with weight loss surgery. Major complications include heart attack, stroke, and blood clots. We will discuss all risks and possible complications with you during a personal consultation so that you can make the best decision for you. There are other complications of weight loss surgery including those unique to specific procedures. For example, with the band, patients may experience slippage of the band or erosion of the stomach and there could be port complications, including infection or dislodegment. We will cover complications in more depth during your surgical consultation. At Duke, the mortality rate for gastric bypass is 0.25% which is lower than the national average and lower than that of other centers of excellence.

Although gastric banding has its own unique complications, it has a very low mortality rate. At Duke, mortality associated with gastric banding is less than 1%. There are many health benefits of bariatric surgery in addition to weight loss. In our program, sleep apnea was resolved in four years in over 85% of patients and diabetes in over 76% of patients. In fact, more than 95% of our patients experienced either complete resolution or major improvement in their diabetes, and 80% saw their high blood pressure improve or resolve. Two major studies recently published in the Mainland Journal of Medicine support what we have seen in our patients.

Studies now show that surgical approaches to weight loss offer real solutions toward these patients for controlling, for even resolving type two diabetes. We have found that healthcare use among severely obese patients decreases after weight loss surgery. Weight loss surgery patients have fewer doctor visits and fewer days in the hospital. A 2004 study showed that healthcare costs for morbidly obese patients who diet alone are 45% higher than those who have weight loss surgery. If you decide to have weight loss surgery, it is important to consider a program credentials. Several national independent groups evaluate weight loss surgery programs to determine if they can be designated as a center of excellence. These are our program credentials.

Duke's program is highly successful in part because we offer a range of surgical choices, are able to individualized options to each patient, and we offer support groups through the Raleigh Durham area. Our surgeons are global leaders in minimally invasive surgical techniques and provide an intense level of personalized attention and care. Duke uses a multidisciplinary approach to care which means that you will be in the care of a world class surgeon as well as a team of healthcare providers. Here is our team. You've already taken the first step toward weight loss surgery at Duke by attending this online patient education session. We know this is a big decision for you, one that is important to your future health and wellbeing. We are looking forward to helping you on your journey to better health.

The next step toward this journey is to check with your health insurance provider. Call the number on your card, and ask if weight loss surgery is covered by your policy. Have the procedure codes ready, they are listed here.

The next critical question to ask is, are there any exclusions in my policy? We can work with you to help make sure the surgery is covered as long as there is not an exclusion. After contacting your insurance company, you then can complete a new patient application. To access the online application and to get more information, go to dukewls.org. After submitting your application online, a member of our staff will contact you to schedule your first appointment. At this new patient appointment, you will meet with members of our multi disciplinary team. Together, we will address all of your concerns and answer all of your questions so that you can decide if the surgery is right for you.

You are welcome to bring a loved one or trusted friend to this consultation. In fact, we encourage you to do so. Once you have met all the requirements, we'll schedule you for a pre-op visit. Your surgery will be at either Duke Regional Hospital or Duke Raleigh Hospital. Thank you for watching.

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