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Bariatric Surgery

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Sandra Gregory

on 28 May 2013

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Transcript of Bariatric Surgery

Diagnostic Criteria Good Candidates
Have not achieved adequate weight loss with lifestyle and medical management
High risk of morbidity and mortality
Suffering from the complications of obesity What is it? Bariatric surgery involves different
surgical procedures that alter
the GI system


Main Goals:
- Promote and maintain weight loss
- Improve weight related co-morbidities Types of Surgery
Adjustable gastric banding
Vertical sleeve gastrectomy Potential Complications & Side Effects Early Complications
Bleeding
Abdominal pain, bloating
Dumping syndrome Bariatric Surgery As a Treatment of Obesity in Canada Exclusion criteria:
BMI < 35 kg/m2
Age <18 or >65 yo
Medical condition or mental health concerns
Smokers : quit smoking 8 weeks before surgery Roux-en-Y gastric bypass
Biliopancreatic diversion with duodenal switch Restrictive Restrictive & Malabsorptive Late complications
Nausea or vomiting
Excess or loose skin
Small bowel obstruction
Ulcers
Bacterial overproduction Post-Operative Nutrition Recommendations Following a Nutrition Plan After Surgery - to allow staple line in stomach to heal without being stretched
- to help promote weight loss and prevent excess weight gain
- to get individual accustomed to eating smaller amounts of food
- to avoid side effects and complications Purpose

Phase 1: Liquid diet


Phase 2: Pureed foods


Phase 3: Soft, solid foods


Phase 4: Solid foods Eating Guidelines after Bariatric Surgery Phase 1 - Liquid diet Week 2 -
Week 5 Phase 2 - Pureed Foods Phase 3 - Soft, Solid foods Week 6
(up to 8
weeks) Week 11 Week 1 Broth
Unsweetened juice
Milk
Strained cream soup
Sugar-free gelatin Sip fluids slowly
Drink 2-3 ounces (60-90 mL) at a time
lean ground meats
beans
fish Digestive tract may be sensitive to spicy foods or dairy products *incorporate into diet slowly Ground or finely diced meats
Canned or soft fresh fruit
Cooked vegetables Should be able to mash foods with a fork at this stage Phase 4 - Solid Foods Foods To Avoid The Statistics - 1.5 million (5.8%) of Canadians are eligible for bariatric surgery

- Risk of mortality is reduced by 35-39%

- 2,385 surgeries were performed in 2008-09 in Canada, which is double the amount experienced in 2004-05.

- Average wait-time in Canada is 5 years - Carbonated beverages

- High sugar foods

- Fried foods

- Alcohol

- Rice, pasta, soft doughy breads that may cause blockages

- Dry tough meats, stringy vegetables or fruits, nuts, popcorn

- Using straws to drink liquids may cause gas or bloating (Dietitians of Canada, 2011) Conclusion References Questions? egg whites
yogurt
soft fruits & veg Pre-Operative Nutrition (Dietitians of Canada, 2011) - Start making healthier choices months in advance

- Use food labels, check serving sizes, and do not skip meals Currently there is no standard "bariatric diet".
Progression through various diet textures.
Dietitians play an important role for pre and post surgery nutrition education * Ensures willingness and ability to make lifestyle changes - Include protein
- Eat 4-5 times/day
- Liquids 30 min before or after food
- Eat slowly, take small bites
- Chew food well
- Limit meals to 1 cup at a time (Dietitians of Canada, 2011) Bariatric Surgery Across the Country (Obesity Surgery: CBC news, 2010) (Mayo Clinic, 2011) (Karmali S. et al., 2010) (Nelms, Sucher, Lacey & Roth, 2011) (Shahzeer K. et al., 2010) (DC, 2011) (Dietitians of Canada, 2011) Christou, N. (2011) Access to Bariatric (Metabolic) Surgery in Canada. Bariatric Surgery centre of excellence, McGill University Health centre, Montreal, Quebec, Canada. Retrieved from http://www.diabetes.ca/documents/for-professionals/CJD--May_2011--Christou.pdf

Dietitians of Canada (2011). Eating Guidelines after Bariatric Surgery – Solids. Retrieved from http://www.pennutrition.com.rlproxy.upei.ca/viewhandout.aspx?Portal=UbY=&id=JMLoXgc=&PreviewHandout=bA==

Dietitians of Canada. (2011). Bariatric Surgery for the Treatment of Obesity. Retrieved from http://www.pennutrition.com.rlproxy.upei.ca/docviewer.aspx?id=9266

Gastric bypass diet: What to eat after the surgery (2011). Mayo Clinic Staff. Retrieved from http://www.mayoclinic.com/health/gastric-bypass-diet/my00827

Healthy Weight/Obesity - Bariatric Surgery Background (2013). Retrieved from http://www.pennutrition.com.rlproxy.upei.ca/KnowledgePathway.aspx?kpid=15324&trid=820&trcatid=38

Karmali S., Stoklossa C., Sharma A., Stadnyk J., Christiansen S., Cottreau D., & Birch D. (2010) Bariatric Surgery: Clinical Review. Canadian Family Physician Vol 56. Retrieved from http://www.cfp.ca/content/56/9/873.full.pdf

Nelms M, Sucher KP, Lacey K, & Roth SL (2011). Nutrition Therapy & Pathophysiology, 2nd edition. United States: Wadsworth

Obesity Surgery: Availability across the country. (2010) Retrieved from http://www.cbc.ca/news/interactives/map-obesitysurgery/
(used to construct table) Sandra Gregory, Dietetic Intern (Christou, 2011) * Electrolyte and nutrient deficiencies Factors Contributing to Risk for Nutrient Deficiencies (Saltzman and Karl, 2013) (Rickers & McSherry, 2012) Before Surgery After Surgery - Obesity
- Poor diet quality
- Preoperative weight loss - Reduced food intake
- Altered diet quality
- Vomiting
- Reduced gastric acid secretion
- Altered digestion & absorption
- Non-adherance to dietary & supplement recommendations
- Small intestine bacteria overgrowth Prognosis - After surgery, life expectancy increased to 80-81 years compared to no surgery at 78 years


- Mortality rate of 0.3%


Meta-analysis: 136 studies and 22,094 patients
Diabetes was completely resolved in 76.8% and resolved or improved in 86.0%
Both hyperlipidemia and hypertension resolved or improved in 87.1% (Rickers & McSherry, 2012) (Polymeris, Karoutsou & Michalakis, 2013) Opportunity for new research to be conducted for expansion of evidence- based guidelines. Future Direction Ghrelin - stimulates hunger Leptin - decreases hunger, sends signals to brain when full
- the more fat mass the more leptin you produce Peptide YY - peptide released by cells in response to eating Pathophysiology - Changes in Satiety and Hunger Increased Decreased (Korner et al., 2005)
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