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,i
  nfertility,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
• Canadas 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 nobodys 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.