Weight loss: Drugs & Surgery Flashcards
(52 cards)
List the categories of bariatric surgery
Restrictive, Malabsorptive, and Mixed procedures
How many individuals with a BMI >35kg/m2 are eligible for bariatric surgery?
1 in 171 individuals
What are some issues highlighted in the Obesity Canada Report Card?
▪ Certified bariatric designation is growing.
▪ No official guidelines or policies for obesity treatment and management.
▪ Lacking interdisciplinary teams in primary care.
▪ Patients often cover costs of meal replacements ($1000-2000/month).
▪ Obesity medications are not covered through public drug benefit programs.
▪ Limited access to surgery with long wait times.
What BMI qualifies a patient for bariatric surgery, or what BMI with comorbidity?
A BMI > 40 kg/m2, or a BMI between 35-40 kg/m2 with a major medical comorbidity
List examples of obesity-related comorbidities that may warrant bariatric surgery.
Diabetes, hypertension, cardiovascular disease, obstructive sleep apnea
What are the eligibility requirements beyond BMI for bariatric surgery?
▪ Strong desire for weight loss
▪ Understanding of the impact of surgery
▪ Comorbidities that are known to improve with weight loss
▪ Severe sleep apnea
▪ Severe diabetes
▪ Physical problem interfering with lifestyle
What are the contraindications for bariatric surgery?
▪ >60 years of age
▪ Medical conditions making surgery at “high risk”
▪mPregnancy
▪ Genetic conditions (e.g. Prader-Willi)
▪ Certain mental health disorders (suicide attempts)
▪ Substance/alcohol abuse
▪ Poor attendance + refusal to make lifestyle changes
▪ Unable to comprehend advice
What services does the Edmonton Adult Bariatric Specialty Clinic provide?
Medical, psychological, and surgical interventions for weight managemen
What does the initial clinic assessment at the Edmonton Adult Bariatric Specialty Clinic determine?
Patient-specific barriers to weight management
What interventions are included in an individualized care plan at the Edmonton Adult Bariatric Specialty Clinic?
▪ Behavior modification
▪ Counseling for nutrition, physical activity, and mental health
▪ Drug treatment and/or bariatric surgery
What is the primary mechanism of restrictive bariatric procedures?
Restricting the amount of food the stomach can hold without interfering with normal digestion
How do restrictive procedures affect digestion?
They do not interfere with normal digestion
What is the primary mechanism of malabsorptive bariatric procedures?
Combining stomach restriction with a partial bypass of the small intestine to reduce calorie and nutrient absorption
List the advantages of Adjustable Gastric Banding (AGB)
▪ Simple and relatively safe
▪ Very short recovery period
▪ Major complication rate is low
▪ No altering of the natural anatomy
What are the disadvantages of Adjustable Gastric Banding (AGB)?
▪ >5% percent failure rate
▪ Slower initial weight loss
▪ In some cases, weight loss may be less pronounced than other surgeries
▪ Less improvement of diabetes than with bypass
List the advantages of Sleeve Gastrectomy.
▪ No insertion of foreign objects
▪ Reduces food intake (removes Ghrelin Cell mass: lower hunger)
▪ No malabsorption of nutrients
▪ Low potential for leakage
What are the disadvantages of Sleeve Gastrectomy?
▪ Irreversible
▪ Inadequate weight loss/gain
▪ Newer technique… more unknown. Stretch of sleeve?
▪ Complications are rare but serious – if a leak occurs, takes months to resolve
How does Roux-en-Y Gastric Bypass (RGB) work?
A small pouch is created to restrict food intake, and a Y-shaped section of the small intestine is attached to the pouch to bypass the lower stomach, duodenum, and first portion of the jejunum
List the advantages of Roux-en-Y Gastric Bypass (RGB).
▪ Significant weight loss
▪ Greatly controls food intake
▪ Reversible in an emergency - though this procedure should be thought of as permanent
▪ Minimal diet restriction
What are the disadvantages of Roux-en-Y Gastric Bypass (RGB)?
▪ Staple line failure
▪ Ulcers
▪ Narrowing/blockage of the stoma
▪ Vomiting if food is not properly chewed or eaten too quickly
▪ Risk of deficiencies in vitamins (B12)
What is dumping syndrome and how can it be avoided?
Dumping syndrome involves feelings of hypoglycemia and can be avoided by changing diet, eating smaller meals, and limiting high sugar foods
List potential complications of abdominal surgery in general.
▪ Infection
▪ Hemorrhage
▪ Hernia
▪ Bowel obstruction
▪ Anastomotic leakage
▪ Dumping syndrome
▪ Nutritional deficiencies
▪ Increased risk of death in first 3 months (including increased risk of suicide)
What are other disadvantages of bariatric surgery?
▪ High Cost
▪ Waiting lists
▪ Many eligible patients don’t want surgery
▪ Large amount of resources pre- and post operation (other complications)
▪ Potential need for body countering surgery
What psychological effects might occur after bariatric surgery?
▪ Grieve the loss of food
▪ Increase in self-esteem and self-confidence
▪ Changes in social circles
▪ Difficulty with social and business functions that revolve around food
▪ Resentment to suddenly improved social acceptance
