Welcome
Thank you for your interest in surgical treatment of obesity. Enclosed is a packet of information to help educate you about the benefits and risks of weight loss surgery. In addition, you will find information on support groups, and questionnaires that must be completed prior to your first visit. We hope you find this information beneficial.

We ask that all patients verify insurance benefits prior to their first visit. This helps the process of pre-certifying your surgery.

Introduction to Weight Loss Surgery for Morbid Obesity
Lack of respect for the morbidly obese is an issue of concern. A survey of clinically obese individuals found that nearly eighty percent reported being treated disrespectfully by the medical profession. There are widespread negative attitudes that the clinically obese adult is weak willed, ugly, awkward, self-indulgent and immoral. This intense prejudice cuts across age, sex, religion, race and socioeconomic status. Numerous studies have documented the stigmatization of obese persons in most areas of social functioning. This can promote psychological distress and increase the risk of developing a psychological disorder. The clinically obese patient is at risk for affective, anxiety and substance abuse disorders. The clinically obese often consider their condition as a greater handicap than deafness, dyslexia or blindness.

It is our philosophy to treat patients with the utmost respect. Our group, physicians and staff, are experienced in treating obese patients, and will do everything possible to support you during this process. We understand the needs of obese patients and work towards providing a system where better health is achieved. Follow-up care is provided for one year, after which we strongly encourage our patients to return for annual exams to make sure all blood levels are normal. Moreover, we maintain a support group for patients, and also keep them informed with a quarterly newsletter which is accessible on our website.

Morbid Obesity Defined:
Morbid obesity is a chronic condition that is very difficult to treat. Morbid obesity is not a simple disorder of willpower, as sometimes implied, but is a complex disorder of energy metabolism. The contributing causes are genetic, environmental, cultural, socioeconomic and psychological. Body mass index (BMI) is a calculation used to determine an individuals overall height to weight ratio. Morbid obesity is defined by having a BMI greater than 40, which occurs when an individual is more than 100 pounds over their ideal weight. These individuals are, therefore, candidates for surgery. Surgery also may be an option for people with a BMI between 35 and 40 who suffer from life-threatening cardiopulmonary problems (for example, severe sleep apnea or obesity-related heart disease) or diabetes. However, as in other treatments for obesity, successful results depend mainly on motivation and behavior. Obesity is dangerous to health because of the effect it has on our body. Obesity causes other body organs and joints to function beyond the capacity for which they were intended. Once these organs reach their capacity they cannot function as desired.

Treatment Objectives
The objective of performing weight loss surgery is to help individuals lose weight they have been unable to lose using other methods. In turn, these individuals should have improved health and quality of life. Prevention of secondary complications of clinical obesity is an important goal of management.

Surgical treatment is medically necessary because it is the only possibility for long-term weight control for the clinically obese. Surgical treatment is not a cosmetic procedure. Surgical treatment does not involve the removal of adipose tissue (fat) by suction or excision. Success of surgical treatment must begin with realistic goals and progress through the best possible use of tested operations.

BACK TO TOP

What are the Surgical Options?

Roux-en-Y Gastric Bypass:
This is considered a restrictive and slightly malabsorptive weight loss operation. This surgery combines the creation of a small stomach pouch to restrict food intake and construction of an intestinal bypass of the duodenum and other segments of the small intestine to cause slight malabsorption. Gastric Bypass surgery produces slightly more weight loss than purely restrictive operations that only decrease food intake. Patients who have Gastric Bypass can expect to lose approximately 70% of their excess weight within one to two years.

Lap-Band:
The Lap-Band adjustable gastric banding procedure restricts the amount of food the stomach can hold by placing an inflatable silicone band around the upper part of the stomach. The new, small stomach pouch limits the amount of food that can be consumed at one time, and a subsequent reduction in food intake results in weight loss.

If you are interested in Lap-Band surgery, please view the following website prior to your consultation: www.lapbandemmi.com.

Gastric bypass operations also cause "dumping syndrome," whereby stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, abdominal cramping and diarrhea after eating. Dumping sometimes occurs from eating concentrated sweets such as cookies, cake donuts, and high calorie liquids. Patients may have to lie down until the symptoms pass. This does not occur with Lap-Band, therefore patients undergoing this surgery need to be a bit more motivated to stay away from sweets.

Who performs these surgeries?
Doctors Robert Quaid, James Dickinson and Stefan Pettine and Michael Roller perform these weight loss surgeries that are discussed in this packet. Our doctors are general surgeons who are board certified and are associated with the American Society for Bariatric Surgery and also the American College of Surgeons. Northern Colorado Surgical Associates, P.C. has performed over 2000 of these surgeries with extremely successful results. NCSA, along with Poudre Valley Hospital has been designated as a Center of Excellence by the ASBS. We have also received Center of Excellence designations from Blue Cross/Blue Sheild and Cigna Insurance companies.

Throughout the process you will be under the care of Becki Mudgett, RN, CBN (Certified Bariatric Nurse). Becki has been with NCSA since 1995 and has significant interest and experience within the bariatric field. She is very active in the ASBS Allied Health Science Section having served as Membership Chair for 5 years. She facilitates the Light for Life support group and is Editor of the Light for Life newsletter.

BACK TO TOP

What are the Benefits and Risks?
Weight loss surgery is a serious undertaking. Each individual should clearly understand what the proposed operation and risks involved with each surgery. Patients and physicians should carefully consider the following benefits and risks before deciding to move forward with the operation:

Benefits:

• Immediately following GBP surgery, most patients lose weight rapidly (ten or more pounds a month for the first six months). Weight loss will slow down toward the end of the first year. GBP patients will realize about a 70% excess weight loss. Lap-Band patients will lose weight slower (one to two pounds per week) and will realize about a 60% excess weight loss.
• The resulting dramatic weight loss improves most obesity-related conditions including arthritis, blood sugar levels, pulmonary conditions, cardiac conditions and lower back pain which should lead to a substantial improvement in quality of life.

Risks:

• Complications can occur. About 5% of patients who have weight loss operations require follow up operations to correct complications. These complications can include leaks, bleeding, perforation and band slippage.
• About 25% of patients who have gastric surgery develop gallstones. During rapid weight loss a person's risk of developing gallstones is increased. If that occurs, we will remove your gallbladder.
• There is a possibility for patients to develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can usually be avoided if vitamin and mineral intakes are maintained.
• Women of childbearing age should avoid pregnancy until their weight becomes stable; usually 1 -2 years. Weight loss and nutritional deficiencies can harm a developing fetus.
• Your doctor will discuss the risks of surgery during your consultation.

Additional Resources:
www.asbs.org
www.obesityhelp.com
www.ncsurgical.net
www.pvhs.org

BACK TO TOP

Possible Complications During the Postoperative Period
(up to one year after the surgery)

1. Nausea, vomiting, bloating and / or heartburn caused from

• Eating or drinking too quickly
• Not chewing food adequately
• Eating too much (quantity)
• Using drinking straws
• Eating rich or sweet foods
• Eating gas-producing foods or drinking carbonated beverages
• Eating foods that are unusually distressful to the stomach
• Band slippage

2. Dumping Syndrome (Gastric Bypass)
This occurs when food, high in sugar, is dumped from the stomach into the intestine, which may result in a feeling of abdominal fullness, nausea, weakness, warmth, rapid pulse, or cold sweats. The patient usually will have abdominal cramping and diarrhea. To avoid "Dumping Syndrome":

• Avoid concentrated sweets
• Do not drink with meals. Take fluids 30 to 40 minutes before or after meals.

3. Blockage of the Stoma
The new opening created by the surgery is smaller than the original opening that released food from the stomach into the small intestine. This new opening may become blocked when food has not been thoroughly chewed; this may result in vomiting. To prevent blockage from occurring:

• Chew all food to the consistency of applesauce before swallowing.
• Foods high in fiber, such as pineapple, asparagus and celery can cause blockage if they are not chewed thoroughly. Beef may also pose a problem.
• Remember to chew food well.

4. Overeating
The purpose of this surgery is to create a smaller stomach; therefore it cannot hold large volumes of food. Constant overeating can stretch the pouch. This is prevented by:

• Eating only three small meals and two or three snacks each day.
• Eating slowly, allowing the nerve receptors in the stomach time to relay the message to the brain that the stomach is full.
• Stop eating as soon as a full feeling is experienced.
• Constant nibbling of foods may reduce the amount of weight lost, especially when consuming foods and beverages that are high in calories and low nutritive value.

5. Anemia / Hair loss
Anemia occurs most commonly with pre-menopausal women and is easily treated with iron supplements. With rapid weight loss there is usually some hair loss. This is minimized by an increased intake of protein and vitamins. Hair loss usually stops when most of your weight has been lost. Patient's hair will grow back.

BACK TO TOP

Is the Surgery Right for You?

Are You?

• Unlikely to lose weight successfully with (further) non-surgical measures?
• Well informed about the surgical procedure and the effects of treatment?
• Determined to lose weight and improve your health and lifestyle?
• Willing to accept responsibility for making necessary changes in dietary habits, knowing that the more compliant you are, the more success you will attain?
• Aware of how your life will change after the operation (adjusting to the side effects of the surgery, including need to chew well, the inability to eat large meals, and the need for vitamin supplements and lifelong follow up care)?
• Aware of the potential for serious complications, the associated dietary restrictions, and the occasional failures?
• Free of any severe psychological, emotional or medical problems which would make the surgery unsuccessful?
• An individual who is not drug or alcohol dependent, unless well into a qualified treatment program?
• Committed to lifelong medical follow up?

Do You?

• Have a body mass index of 40 or more?
• Have a body mass index of 35 with serious health problems aggravated by obesity?
• Have an obesity related physical problem such as body size that interferes with employment, walking or family function?
• Have high-risk obesity-related health problems such as severe sleep apnea, arthritis, pulmonary problems or obesity related heart disease?
• Understand that the surgical procedure is only part of the total treatment program for obesity? Furthermore, do you agree to accept the outcome of surgery, sign an informed consent, and cooperate with recommendations and guidelines and long-term follow-up?

BACK TO TOP

Initial Consultation
We realize how intimidating and overwhelming contemplation of surgery can be. That is why we suggest you make an appointment for an initial consultation. The first visit will last approximately 2-3 hours and will include viewing of an educational video, as well as an opportunity for our staff to address any questions or concerns you may have. We strongly encourage you to bring your spouse, significant other, a friend or family member to this initial visit. Please do not bring young children

What Can I Expect After Surgery?
As you consider Gastric Bypass or Lap-Band as a solution for your obesity, it is important you understand the operation is an excellent means of managing your weight, but its success depends on you making significant lifestyle changes. This operation will bring about weight loss by forcing you to change your eating habits. The greatest success is realized by patients who are positive in their attitude about adjusting their eating patterns. For a successful outcome, it will be necessary for you to exercise regularly and follow special post-operative dietary guidelines. Many bariatric patients lose 100 pounds or more during the first year following surgery. In addition to having a positive impact on their physical well-being, they are more active, emotionally healthier and enjoy a higher quality of life. Many who have previously taken insulin for diabetes or medication for high blood pressure no longer require treatment.

Perhaps the most significant change following gastric bypass surgery is your loss of hunger. Your medical team will prescribe a dietary program to help you achieve your weight loss goal, while maintaining good health after surgery. The primary objective is to eat foods with highest possible nutritional value. Because you should lose weight at a very rapid rate, proper nutrients are absolutely essential to maintain muscle tone, skin elasticity and to minimize hair loss.

During the first two weeks following surgery, you will be sipping liquids and pureed food designated by your medical team. Soft foods will be added into your meals after your first post operative visit. After six - eight weeks or when your Doctor feels adequate healing has taken place, you may begin to slowly add regular food into your diet. Your proteins will come mainly from foods such as chicken, turkey, fish and limited quantities of beef, low-fat cheese, string cheese, cottage cheese, yogurt and eggs. You are discouraged from eating fats and sugars because they can cause "dumping syndrome" as mentioned earlier. Alcoholic beverages should be avoided or consumed infrequently. Alcoholic beverages, including beer, wine and liquor, are high in calories, often carbonated and are extremely hard on your stomach. Because your usable stomach will be drastically reduced, it is very important that you take good care of it. Alcohol injury to the stomach pouch is potentially a serious problem. Carbonation in beverages causes belching and bloating, which may exert stress on your tiny stomach, resulting in dilation or enlargement. Successful weight loss and long-term maintenance is directly dependent upon the kinds of foods and beverages consumed. Since carbonated beverages offer no advantages and present significant potential disadvantages, they should be avoided.

Lap-Band patients will need to take a multi-vitamin with iron and calcium supplements. GBP patients will need to take a multi-vitamin, calcium and Vitamin B12 each day for the rest of your life. You will not be able to take most over the counter anti- inflammatory medications. Other medications are usually fine to take.

Exercise is an essential part of your long-term care and treatment and should begin after your first follow-up visit. Begin by walking 10-20 minutes each day and work up to 30-40 minutes three to four times a week, or as your physician recommends. Exercise will increase overall energy, maximize fatty tissue weight loss, reduce muscle breakdown and burn calories.

BACK TO TOP

General Information
The GBP surgery usually requires a hospital stay of two days. Lap-Band patients will usually be in the hospital one day. Each individual recovers from the surgery at a different rate. If you live more than an hour away from Ft. Collins you may need to remain in the area for a few days after discharge from the hospital. Contact Volunteer services at Poudre Valley Hospital (495-8580) for lodging options & reduced rates. It generally takes about two to four weeks to recover from laparoscopic weight loss surgery. If you have a desk job, you can usually return to work three weeks after discharge from the hospital.

It is extremely important to keep follow-up appointments. Your first follow-up visit will be about two weeks after surgery. At that time, we will discuss your diet. And make other recommendations regarding the surgery. Follow up appointments for GBP patients include 6 weeks, 3 months, 6 months, 9 months and 1 year and yearly, thereafter. Lap-Band patients will be seen at 2 weeks, 6 weeks, and then monthly for the first year. We will see you 2 or 3 times or as needed during the second and third year and yearly thereafter.

We have a lifetime commitment to patients who undergo weight loss surgery. To avoid long-term problems, we recommend you come into the office once a year for complete blood work. If you live a long distance away and cannot travel for the yearly follow-up, we ask that you have your general physician perform these tests and send a copy of the results to out office.

The primary goal of our medical team is to improve your health. We also want you to make an informed decision about taking this step by being fully aware of the responsibilities, possible complications and benefits of the program. The decision to move forward with surgery belongs to you and your family doctor. Should you elect to have gastric bypass surgery, you will receive dietary, exercise and behavior modification guidelines to assist you. The tools and support are designed to help you achieve success and maintain long term goals. By taking responsibility to follow these guidelines you will maximize your overall success and minimize potential complications.

Support Group Information
A support group called Light for Life has been organized as part of our continuing efforts to provide Bariatric Surgery patients with the tools necessary to complete their post-operative care. Becki Mudgett, R.N. has led the development of this group and to date it has been well attended by former and prospective patients alike.

We strongly urge you to attend the Light for Life support group meetings regularly during the first year following surgery. One meeting should be attended prior to surgery.

The group meets on the last Monday of every month at Poudre Valley Hospital in Café F, Basement level, behind cafeteria. During the meeting, which lasts from 6:00 to 8:00 PM, the group focuses on topics related to Bariatric surgery. Topics include nutritional support, behavioral enhancement, stress management, psycho-social issues and exercise. These meeting are open to all and we encourage spouses and friends to attend as well.

Living Positively After Bariatric Surgery support group meets the 2nd Monday of each month from 6:30 to 8:00pm. This support group is facilitated by Dr. Betty Vanek, PhD and is held in the Indian Paint Brush meeting room at Poudre Valley Hospital. This support group is designed to address any psych-social issues and there is a $20.00 fee per meeting.

For more information visit these websites:
www.asbs.org
www.obesityhelp.com

BACK TO TOP