Bariatric Surgery

Question 1

What is Morbid Obesity?

Answer 1

BMI >40 or BMI >35 with comorbid conditions
200% more than ideal weight
100 lbs overweight

Question 2

What are the classifications of obesity?

Answer 2

Class I: BMI 30.0-34.9

Class II: BMI 35.0-39.9

Class III: BMI 40.0 and above

Question 3

What are the three main factors that affect obesity?

Answer 3

1. genetic
2. behavioral
3. environmental

Question 4

What is the Gastric Bypass Roux-en-Y procedure?

Answer 4

pouch is made
duodenum is bypassed
jejunum is attached to the pouch

Question 5

What is the average weight loss for Gastric Bypass?

Answer 5

77% in 1-1.5 years

at 10 years, usually regain about 10-15%

Question 6

What are the complications associated with Gastric Bypass?

Answer 6

peritonitis, abdominal wall hernia, staple line disruption, wound infection, GI symptoms, blood clots, nutritional def.

Question 7

what are some of the long term risks of bypass?

Answer 7

Internal hernia
Bowel Obstruction or blockage
Narrowing of one of the intestinal connections
Flatulence/Gas
Diarrhea/Constipation
Failure to Lose Weight/Weight Re-gain
Vitamin Deficiencies/Malnutrition
Ulcers

Question 8

true or false: people lose more weight by changing their diet than by doing a bariatric surgery?

Answer 8

FALSE

Question 9

What are some of the benefits of Gastric Bypass?

Answer 9

1. Diabetes: 90% become diet controlled
   (Most patients leave the hospital on NO medicines)
2. High blood pressure: 66% resolved; 33% less medications
3. Reflux/Heartburn: 95% resolved
4. Sleep apnea: 90 % resolved
5. Stress Incontinence: 90% resolved
6. High cholesterol/triglyceride: 90% resolved

Question 10

What needs to be considered from a nutrition stand point for bypass surgery?

Answer 10

the surgery is restrictive (1 0z an hour) and malabsorptive

• protein energy malnutrition
• vitamin and mineral malabsorption
• adequate hydration

Question 11

Obese individuals are at risk for several macronutrient deficiencies. What are they?

Answer 11

Iron
Vit D, E, C
B-12
Protein

Question 12

is gastric bypass surgery reversible?

Answer 12

yes

Question 13

What is the laparoscopic sleeve gastrectomy?

Answer 13

New procedure

non-reversible

Causes restriction by making the stomach a long narrow tube

No malabsorption

Question 14

sleeve surgery helps reduce what appetite stimulant?

Answer 14

grehlin

Question 15

What are the risks associated with sleeve surgery?

Answer 15

operation risks and n/v

Question 16

What are the benefits of sleeve surgery?

Answer 16

• NO dumping syndrome
• NO internal hernia
• LESS vit def., protein malnutrition, anemia, and osteoporosis

Question 17

What is an alternative for the sleeve procedure?

Answer 17

staged procedure.

Question 18

What needs to be considered from a nutrition stand point for sleeve surgery?

Answer 18

the surgery is restrictive and malabsorptive

• protein energy malnutrition
• vitamin and mineral malabsorption
• adequate hydration

Question 19

What is gastric banding?

Answer 19

• Molds the stomach into two connected chambers
• Limits the amount of food that can be eaten at one time
• Upper stomach can only hold approximately ½ cup of food

Question 20

What is the goal of gastric banding?

Answer 20

lose 1-2 pounds a week

do this by tightening and loosening the band

Question 21

What are some risks associated with gastric banding?

Answer 21

band slips and erosions
Port flips
Tubing-related complications (port disconnection, tubing kinking)
Band leak
Esophageal spasm
Gastroesophageal reflux disease (GERD)
Inflammation of the esophagus or stomach
Port-site infection

Question 22

what has gastric banding been shown to improve besides weight?

Answer 22

diabetes, htn, joint pain, sleep apnea, GERD

Question 23

What is Biliopancreatic Diversion with or without Duodenal Switch?

Answer 23

combo of bypass and sleeve

Question 24

What are the nutrition goals post surgery?

Answer 24

0-6 months post op:

60-70 grams protein /day
90 or less grams CHO/day
-initially significantly less
<1300 cals/day