1. Welcome To the Water Tower Surgery Weight Loss Center, SC Patient Information Session

2. MEET OUR SURGEON Dr. Frederick Tiesenga

3. WHAT IS OBESITY? Obesity is an excess of body fat frequently resulting in a significant impairment of health (NIH Consensus Statement, 1985)

4. OBESITY: CONTRIBUTING FACTORS A simple explanation given for obesity is overeating.

5. OBESITY: CONTRIBUTING FACTORS Endocrine (hypothyroidism, etc.) Genetic influence (?Ob gene, etc.): increased rate accumulation fat, more fat cells, larger fat cells. Increased fat storage? Psychological factors: depression, low self-esteem, social anxiety, poor stress management skills. Social factors: social relationships (family, friends, social and business clubs) with activities planned involving eating.

7. OBESITY BY THE NUMBERS OBESITY BY THE NUMBERS The percentage of Obese American Adults almost doubled since 1960 (American Obesity Association, 1999) U.S. Adult Population 39 MILLION

12. OBESITY BY THE NUMBERS Nearly 25 percent of American children and adolescents are overweight – double the percentage from 30 years ago. About 5 to 10% of children are obese.

13. OBESITY BY THE NUMBERS Between 13 and 23% of all adolescents are obese. 80% of obese teenagers are likely to grow into obese adults.

14. OBESITY: HEALTH CONDITIONS Poor diet and sedentary lifestyle are responsible for between 300,000 and 587,000 deaths per year, making obesity the second leading cause of preventable death after smoking Obesity is an independent risk factor or an aggravating agent for approximately 30 conditions

15. OBESITY: CO-MORBIDITIES Diabetes Gallbladder disease Heart Disease Osteoarthritis and gout Rheumatoid Arthritis Pulmonary problems and sleep apnea Cancer (Breast, Colorectal, Endometrial) Renal Disease Hypertension Liver Disease Stroke Urinary Incontinence

16. OBESITY: CO-MORBIDITY FACTS 80% of NIDDM patients are obese 70% of diagnosed cases Cardiovascular disease are related to obesity For each 10% increase in body weight: 20% increase in CAD, systolic blood pressure increases 6.5mmHg, plasma cholesterol 12 mg/dl, fasting blood glucose 2mg/dl (Obesity and Health-An Overview, 1999)

17. DIRECT COST RELATED TO OBESITY (The Lewin Group Study, 1999)

18. BODY MASS INDEX (BMI) THE CURRENT BEST METHOD TO MEASURE OBESITY Is a simple math calculation that determines weight-to-height ratio. IT CAN BE CALCULATED USING the formula: kg/m 2 (or lbs/inches 2 X 704.5).

19. BMI RANGES BMI RANGES (Metropolitan Life insurance Company table data) < 19 UNDERWEIGHT 19-25 NORMAL 26-29 OVERWEIGHT 30-40 OBESITY > 40 MORBID OBESITY BMI 40 = APPROX 100 lbs above desirable weight

20. PROBLEMS OF MORBID OBESITY 10% people in USA are morbid obese BMI>30 (Obesity):55% increase in mortality, 70% increase from CAD, 75% increase from stroke, 400% increase from diabetes (American Obesity Association) Morbidly obese young men between the ages of 25 and 35 have 12 times the chance of dying as men of normal weight. A morbidly obese adult has only one-third the chance of living to age 65 as that of a person who is of normal weight.

21. REDUCED LIFE EXPECTANCY MORTALITY RATIO % Body Mass Index (Kg/m 2 ) NIH, NEJM. 1995

22. PROBLEMS OF MORBID OBESITY Physical Limitations: Particular difficulties can occur with: Sporting and outdoor activities Clothes Personal hygiene Travel Psychosocial Disability: Low self-esteem Low self confidence Reduced employability Depression Decreased Libido Social isolation

23. Medical therapy for obesity Dieting Behavior Modification Regular Physical Exercise Drugs (malabsorptive, appetite suppressants, etc.) Support groups (weight watchers, etc.)

24. MEDICAL THERAPY FOR OBESITY What are the realistic expectations? An optimal and continuous program which uses:diet, tablets, behavior modification and exercise can expect to achieve and maintain a weight loss of 10 kg (22 lbs) if continued permanently 95% return to pre-diet weight (Adkinson, Am J. Clinical Nutrition, 1994)

25. What are the Options between Medical and Surgical Treatment? There are none!!!

26. SURGICAL THERAPY FOR OBESITY GOAL of Obesity Surgery: Improve Health Improve Quality of Life Increase the Duration of Survival

27. LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAP-BAND) The capacity of the stomach is made smaller by placing an adjustable band around the upper part of the stomach. No cutting or stapling The feeling of satiety (fullness) is achieved when the small stomach pouch above the band is full.

28. LAP-BAND SURGERY It is a Laparoscopic surgery Adjustable Reversible Short Hospital Stay hospital stay is < 24 hours Quicker recovery : walking/drinking liquids in 4-6 hours after surgery, normal activities in few days Less Morbidity/Mortality than any other operation for Morbid Obesity

29. LAP-BAND SLIPPAGE

30. O’Brien Study (302 patients) 1999: No. slippages First 50 patients:15 Second 50 patients:7 Third 50 patients:3 Fourth 50 patients:2 Last 100 patients:0

31. Recovery Time For the Lap Band you can expect to be back to work in about two weeks. If you are currently taking medication, please alert your surgeon so they can discuss your prescription treatment with your primary doctor.

32. Diet Post-Op Diet Post-Op The First One to Four Weeks: Liquids and very soft food (soup, yogurt, juices, jello, skim milk, etc.). Four to Six Weeks: Slightly thicker diet. Switch gradually to solid food.

33. Lap Band Diet Post-Op After Six Weeks: Solid food following this rules: Eat three small meals a day Eat slowly and chew thoroughly Stop eating when felling full Do not drink while eating Avoid fibrous food Drink enough fluids during day

34. GB/VBG/LAP-BAND RESULTS % EWL Months

35. DIABETES O’Brien Study (Australia, 1999) 302 patients: 9.7% diabetics 54% became “non-diabetics” (no sx, no Rx, nl biochemestry) 43% were improved (easier to control, less Rx, improved biochemestry) One pt. Remained unchanged

36. HYPERTENSION O’Brien Study (1999): Prevalence 33% At 12 months: Out of 88 patients with HTN, 75 had normal BP, and only 27 were on Rx. Outcome: Resolved (nl BP, no Rx) 52 (59%) Improved (Easy control, less Rx) 29 (33%) Unchanged 7 (8%)

37. LAP-BAND RESULTS 287 lbs/BMI 46.3 Sep. 26, 2001 165 lbs/BMI 27 !!! April 30, 2002

38. LAP-BAND RESULTS 224 lbs/BMI 36 June 25, 2001 149 lbs/BMI 23!!! Feb. 1, 2002

39. LAP-BAND RESULTS 379.9 lbs/BMI 66 Oct. 17, 2000 229 lbs/BMI 39!!! Feb. 1, 2002

40. LAP-BAND RESULTS 263 lbs/BMI 41 Dec. 1, 2000 190 lbs/BMI 29!!! Dec. 1, 2001

41. LAP-BAND RESULTS 292 lbs/BMI 43.2 Mar. 25, 2001 217 lbs/BMI 32!!! Mar. 8, 2002

42. LAP-BAND RESULTS 273 lbs/BMI 43.3 Nov. 30, 2000 171 lbs/BMI 27 !!! Mar. 1, 2002

43. Lap-Band Patient 77 lbs in 14 months 262 lbs July 24,2002 210 lbs April 30, 2003 185 lbs October 8, 2003

44. Lap Band Patient 75 lbs weight loss in 8 months 315 lbs November 18, 2002 240 lbs October 9, 2003

45. Our Pre-Op Screening Medical Evaluation with one of our surgeon Nutritional Evaluation Psychological Evaluation Labs (CBC, CMP, U/A, Lipid profile, pregnancy test, Upper GI and ultrasound if necessary) Minimum Follow up: One year

46. Our qualification process… Complete the patient information packet in its entirety and return it as soon as possible. We will then complete an insurance benefit verification with your insurance on what your bariatric coverage may be. Once we have determined your coverage and received and reviewed your packet, we will contact you for additional testing that may be needed (Psych & Dietary).

47. What you can expect on your first visit….. One on One Consultation with the surgeon. Review any pre-surgical care that may be needed.

48. Pre-Surgical Financial Consultation If your insurance requires you to satisfy a deductible or co-insurance amount, we ask that you pay that prior to your surgery. If you are a self-pay patient, financial arrangements must be done prior to your surgery.

49. QUESTIONS and ANSWERS???