Bariatric Clinic

1. Bariatric Clinic

2. Centers of Excellence Ontario Government is increasing treatment capacity by over 750% Guelph General Hospital is one of 5 Centers of Excellence for Bariatric Surgery (Gastric Bypass) in Ontario. (2 assessment centers) 240 Bypass surgeries will be performed at Guelph General Hospital within a fiscal year. ( Dr. K Reed, Dr, Natasha Pereira Hong, Dr. Jules Foute Nelong) Support from Professional Staff for 5 years after surgery

3. Selection of GGH • GGH was selected in 2009 as a centre of excellence due to our expertise in Bariatric surgery • Lead surgeon is Dr K Reed who has be providing this surgery in our community for over 10 years. • Surgeons are required to perform a minimum of 50 Bariatric surgeries each, per year to be considered proficient in bariatric surgery

4. Why? • Obesity is a global epidemic • Obesity is one of the leading causes of preventable death • Excess body fat impacts health which impacts health care costs • In Canada 47% of the population is either overweight or obese. • The proportion of Canadian population which is obese has tripled in the last 15 years • Health problems include: CAD,cancer,hypertension,infertility,chronic muscular and joint problems and respiratory disease.

5. Provincial Guidelines • Age: Usually under age 60, not mandatory • BMI: 40 and over, 35 with some co morbidities such as diabetes • Geographical Center of Excellence closest to you • Psychologically and Medically fit for surgery • Contraindications: • Smoking - need to be smoke free for 6 months • Current substance abuse (alcohol and drugs) • Untreated significant psychiatric illness

6. Who can refer a Patient • Any family doctor • Any Internist • Windsor Bariatric Assessment Clinic referrals are direct to a bariatric surgeon • All referrals go to a central registry

7. Orientation Classes • Twice a month • 20-25 patients plus significant others • “Screens out” inappropriate patients • They are then offered a date to start in clinic • First appointment is 3 hours long to see all three professionals

8. Before Surgery Attend several appointments at the Bariatric Clinic. Meet with the Social Worker, Dietitian and Nurse at least twice though often more times Meet the Surgeon, Anesthetist and possibly an Internist

9. Post op Routine Visit Schedule • Up to 7 visits with various professional in first post op year • Yearly to clinic after 1st year plus one surgeon visit at 18 months

10. Nutrition Counselling Nutritional component includes a comprehensive pre op assessment to evaluate pre operative eating patterns/issues Management of post-operative nutrition begins with pre-operative nutrient status Follow-up to reinforce important principles associated with long term weight loss and life style change

11. Nutrition Assessment Meet with a Registered Dietitian – details re: failed and recent weight loss attempts, lab values (Dyslipidemia) , snacking behaviour, cravings, disordered eating behaviours, food access, intolerances A review of current eating habits – 24 hr. recall Identification of potential beneficial changes Canada’s Food Guide – thorough review; activity Food Journal Reassessment in 6- 8 weeks Need to demonstrate ability to modify poor eating habits

12. Pre/Post-op Dietary Guidelines • OPTIFAST : 2 weeks pre-op meal replacement program to reduce fatty liver • Diet Post-op: 4 stage progression – • Clear fluid • Full fluid • Soft solid • Maintenance diet

13. Psychosocial Assessment • Why now? What is motivating you to have this surgery? What are your expectations? Are they realistic? • Your understanding and ability to commit to the follow up provided by the clinic I.e. at least 3-4 appointments before surgery, at least 6 appointments in the first year following surgery and follow up for 5 years after surgery.

14. Psychosocial Assessment continued…… • The long term commitment to change – no smoking, no illicit drug use, limited alcohol, limited caffeine, no carbonated drinks. • Long term commitment to dietary and lifestyle changes • Budget restraints – cost of travel/parking, time off work for appointments, time off work for surgery, cost of vitamins, cost of Optifast

15. Psychosocial Assessment Continued….. • Anticipating major changes: ongoing medical follow-up, dietary, lifestyle, appearance and relationship changes. • What supports do you have in place to help with this? Do you have individuals in your life who will sabotage you? • Supports that are available i.e. bariatric clinic, support groups etc

16. Psychosocial Assessment Continued • Lifestyle changes – what will need to be changed, what has been challenging to change in the past, what will be different this time, do you know how to make changes, what can you start working on now • What coping strategies have you developed or need to develop to manage the ongoing lifestyle change required

17. Psychosocial Assessment Continued….. • Physical activity – why it is important i.e. to improve health before surgery and to achieve weight loss goal. • How will you incorporate this into their life? Do you have goals? Can you start something now?

18. Psychosocial Assessment Continued • Do you have disordered eating? Any binge eating and/or emotional eating? • What will be different following surgery? • Have you ever received professional help for this? Do you need to or would you be willing to?

19. Psychosocial Assessment • We provide the you, the patient with an opportunity to do a Self Assessment I.e food/activity records, what your goals are, what are your triggers, what worked well, what was challenging • We focus on developing a new routine/plan, learning from past challenges, focusing on the present and recognize that nobody’s perfect.

20. Psychosocial Assessment Continued…. • Assessment of any history of mental health issue/diagnosis and whether this is stable etc. We will contact your mental health professional if appropriate. • Assessment of any history of or current substance abuse challenges • Recommend close follow up of medications that you are on d/t absorption changes etc.