1. September 26, 2008 Colorado Bariatric Surgery Institute Katayun Irani, MD

2. September 26, 2008 Raised in Houston, Texas B.A. - Cornell University M.D. - University of Texas Southwestern Surgical residency New York University Fellowship in Bariatric surgery Legacy Good Samaritan Hospital, Portland Oregon Katy Irani, MD

3. September 26, 2008 What is obesity?

4. September 26, 2008 National Institute of Health – Body Mass Index (BMI) is a measure of body fat based on height versus weight Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD How do we measure Obesity?

5. September 26, 2008 1.Source: Center for Disease Control Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Obesity is an epidemic You AREN'T alone!

6. September 26, 2008 1.Source: Center for Disease Control Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Obesity is an epidemic You AREN'T alone!

7. September 26, 2008 OBESITY Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Obesity is a DISEASE!

8. September 26, 2008 Obesity is a DISEASE! Obesity is a disease of excess fat storage with a number of associated diseases, known as co- morbidities. life-long progressive can be life-threatening expensive Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD

9. September 26, 2008 More than 36% of US adults are obese. 17% of children are obese, with over 30% being overweight. Studies estimate medical cost of obesity over $100 billion. 325,000 obesity-related deaths occur annually. Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Obesity is a deadly!

10. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Obesity is deadly!

11. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Discrimination – Social - Theaters, airlines, restaurants – Employment - New hires, promotions, comments Disabilities Judgement and harassment Obesity is socially difficult

12. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Treatment Options

13. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Diet's DON'T Work!

14. September 26, 2008 Restrictive Limits the amount of food patients can eat by reducing the stomach size Helps patients feel satisfied with less food for longer periods of time Malabsorptive Intestine is rerouted so that food skips a portion of it Digestive enzymes are bypassed and certain foods are not absorbed Both result in hormonal changes that decrease hunger Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD How Surgery Works

15. September 26, 2008 BMI >40 or >35 with significant co-morbidities Psychological evaluation Nutrition evaluation Counseling and classes as needed Healthy enough to undergo a major operation Patients get appropriate preoperative testing for age and comorbidities Absence of drug and alcohol problems Including nicotine Candidates for surgery

16. September 26, 2008 Yes, Bariatric Surgery is SAFE!

17. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Surgical Options

18. September 26, 2008 Laparoscopic Same day surgery Implanted device Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Adjustable Gastric Banding Avg weight loss 40% Falling out of favor in the US.

19. September 26, 2008 SURGICAL TREATMENTS FOR OBESITY I Dr. John Doe, M.D. I November 24, 2008

20. September 26, 2008 Advantages Low short term risk Same day surgery Reversible and convertible to other procedures Disadvantages A lifetime of frequent office visits for adjustments Least weight loss Requires most work to lose weight Longterm risk of slippage, erosion, trouble swallowing Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Adjustable Gastric Banding

21. September 26, 2008 Migration of implant – band erosion, band slippage, port displacement Tubing-related complications – port disconnection, tubing kinking, tubing leak Port-site infection Esophageal dysmotility Gastroesophageal reflux disease (GERD) Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Risks of Adjustable Gastric Banding

22. September 26, 2008 Laparoscopic 1-2 night hospital stay Mean excess weight loss at 1 year of 60-70% No implanted medical device Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Sleeve Gastrectomy

23. September 26, 2008 Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Sleeve Gastrectomy

24. September 26, 2008 Advantages Lower risk than bypass Good weight loss Long term follow up not necessary but encouraged Disadvantages Risk of leak Not reversible Risk of reflux, nausea Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Sleeve Gastrectomy

25. September 26, 2008 Roux-en-Y Gastric Bypass Laparoscopic 1-2 night hospital stay Mean excess weight loss at 1 year of 70-80% No implanted medical device Low rate of complications Colorado Bariatric Surgery Institute I Parker Adventist Hospital I Katayun Irani, MD Roux-en-y Gastric Bypass

26. September 26, 2008 SURGICAL TREATMENTS FOR OBESITY I Dr. John Doe, M.D. I November 24, 2008

27. September 26, 2008 Advantages Best weight loss Reversible Less frequent long term follow up Cures reflux Highest rate of diabetes resolution Disadvantages Highest risk (still low risk) Potential for long term complications Malabsorption Roux-en-y Gastric Bypass

28. September 26, 2008 Leaks from staple lines Bleeding Ulcers (NO NSAIDS, NO SMOKING, NO STEROIDS) Dumping syndrome Vitamin and mineral deficiencies Internal hernia Risks of Roux-en-y Gastric Bypass

29. September 26, 2008 Pneumonia Deep vein thrombosis and pulmonary embolism Bleeding Injury to stomach, esophagus, or surrounding organs Infection Pulmonary embolism Abdominal wall hernia Gallstones Nausea, vomiting and dehydration Death General Operative Risks

30. September 26, 2008 Recovery takes time and patience. 1-2 night hospital stay (except the band) Surgery hurts – Walk! – Breath! Time off work varies but avg 14-21 days THE DIET IS STRICT! – Liquid diet before and after surgery – Soft then regular diet – Some foods will never go down What happens after surgery?

31. September 26, 2008 What happens after surgery?