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Weight Loss CenterWeight Loss CenterNew Patient Orientation

Obesity DefinedOverweight and obesity are defined as body massindex (BMI) ranges above what is consideredhealthy. Healthy BMI 18.5-24.9 Overweight BMI 25-29.9 Obese BMI 30-39.9 Morbidly Obese BMI 40 and above (sometimes BMI 35-39.9 with co-morbidities)SHC ValleyCare Weight Loss Center offerstreatment for obese and morbidly obese patients.

Health Risks of Obesity HypertensionStokeHyperlipidemiaCoronary HeartDiseaseMetabolic SyndromeDiabetesObstructive SleepApnea & Asthma Gallbladder DiseaseUrinary IncontinenceCertain CancersInfertility & PregnancyproblemsOsteoarthritisNon-alcoholic FattyLiverSource: www.rethinkobesity.com

Factors Affecting Weight Control Genetics (40-70%) Appetite and fullness signalsTendency to store or burn body fatEnergy level for activity/exerciseBehavior (Diet and Exercise Habits) Environment (Commute, Job setting,Finances, Living situation, Stress,etc.)

Benefits/Goals of Weight Loss 3-5% weight loss may lower cardiovascular andother disease risk factors, reduce joint pain, andimprove overall health and quality of life5-10% may lower blood pressure, improvediabetes control, sleep apnea, blood lipids, andother weight-related health problems5-10% weight loss at 6 months is targeted goal,with continued involvement for at least 1 year toprevent weight regain.Achieving BMI 25 minimizes all weight-relatedmedical problems.

Stanford Healthcare ValleyCareWeight Loss Programs Medical Weight Loss (Non-surgical) Bariatric Surgery (Surgical)

Non-Surgical Obesity Treatment:What Works?Lifestyle Intervention Counseling produces bestweight loss and health improvements1. High-intensity (In-person, Individual & group, 14sessions in 6 months)2. Diet and exercise guidance3. Behavioral strategies aimed at skill development,meal planning, stopping emotional eating andmaintaining motivation4. Support groups5. Weight loss medications may be added to assistindividuals with diet and behavioral changes*Per 2013 AHA/ACC/TOS Guidelines

Components of Medical WeightLoss Program Doctor Referral neededQuestionnaire completedMedical evaluation by Nurse Practitioner (NP)Group class introduction to diet by registereddietitian (RD)Regular 1:1 visits with NP and/or RDSupport groups and class instruction offeredPharmacologic (medication) therapy considered

Dietary Approach: Low Carb,Real Foods Diet Generally starts with a very low carb diet May be individualized based on assessmentEmphasis on protein, non-starchyvegetables, and healthy fatsGradual expansion to include more “realfoods” containing some carbohydrateRole of portion sizes and timing of mealsRecipe ideas and resourcesNo required supplements to purchase

Skills Development Training Low carb meal planningRole of exercise in weight managementDining out strategiesGrocery shopping & label readingManaging emotional eating & food cravingsStaying motivatedMonitoring changing health conditionsCreating long term habits to maintain lostweight

Obesity Insurance Coverage In June 2013, the American Medical Association labeledobesity as a medical condition/disease.Screening and counseling for obesity may be covered byyour insurer, but is highly variable. Check with your insurer for the specifics of yourcoverage. Call the 800 number on your insurance card ORcheck the website. Ask if obesity treatment (medical or surgical weightloss) is a “covered benefit”? Ask what portion of the cost will be covered? Coverage usually stops when BMI falls below 30.If your visits are not covered by insurance, contact ourfront office for cash pay prices.

Weight Loss Surgery ProgramSurgeons Dr. Mary EstakhriDr. Andrew LeeSurgery Options Roux-En-Y Gastric Bypass (RNY), Sleeve Gastrectomy(SG)Both surgeries help you to get full on smaller portionsand decrease appetiteAlmost all surgeries are done laparoscopically1-2 night hospital stayLapBand may be considered if BMI 35

RNY Gastric Bypass

RNY Gastric Bypass 18.7% of all bariatric surgeries in US (216,000 total surgeriesin 2016)Stomach & small intestines are reconfigured to create a smallpouch of 1-2 oz. Bypasses most of stomach & first part ofintestines.Reduces appetite and enhances satiety; Long-term meal sizeusually 1-1.5 cups/mealCertain vitamins & minerals are malabsorbed, but V&Msupplements taken consistently will compensate, allowing forgood nutritional health.Initially 60-80% excess weight lost; with 50% maintainedlong-term.Requires adherence to dietary recommendations, life-longvitamin/mineral supplementation, and follow-up compliance

Sleeve Gastrectomy

Sleeve Gastrectomy 58.1% of bariatric surgeries in US (216,000 totalin 2016)80-85% of the stomach is removed leaving atube or “sleeve” of 2-5 oz. between theesophagus and pylorus.Reduces appetite and enhances satiety; Mealsize is typically 3/4-1 cup/meal.Initial weight Loss is very comparable to RNYgastric bypass 50% excess wt loss maintained 3-5 yearsProcedure is not reversible

Lifestyle after Bariatric Surgery Surgery is just one tool to help with weight lossA nutrient-dense diet with adequate protein & fluidsConsistent intake of vitamin & mineral supplementsCommitment to no smoking, minimal alcohol andmedication restrictionsRegular exercise or physical activityOngoing monitoring of health conditionsAttention to changes in mental health, relationshipsHealthy sleep hygiene and successful stressmanagementConsideration of support groups

Surgical ConsultCompletequestionnaire prior toinitial evaluationNutrition Evaluation(1.5 hours)PsychologicalevaluationTeam ConferenceComplete requiredgroup class andwritten educationSurgerySurgical, Nutrition andPsychological consults may bedone in any order. Consults,education, & surgery billed toinsurance. Some insurers maynot cover all expenses.

Surgery Insurance Coverage A covered benefit under most insuranceplans, including Medicare and HMOsBe sure to check with your insurancecompany: What is their criteria forcoverage? Most insurance plans require patients toprovide documentation of a recentmedically-supervised weight loss effort,which may be completed at StanfordHealth Care OR with a doctor of yourchoice.

How to Get Started Call our office at 925-416-6720 to scheduleevaluation appointments or with additionalquestions. Contact information for surgeons andpsychotherapists will be provided.Complete Patient History Questionnaire priorto first appointment. This must be completelyfilled out before you arrive!!

Benefits/Goals of Weight Loss 3-5% weight loss may lower cardiovascular and other disease risk factors, reduce joint pain, and improve overall health and quality of life 5-10% may lower blood pressure, improve diabetes control, sleep apnea, blood lipids, and other weight-related health problems 5-10% weight loss at 6 months is targeted goal,

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with weight loss. Conventional, structured weight-loss strategies usually involve limiting total calories4 or a major macronutrient, such as protein, fat, or carbohydrates, to achieve weight-loss success.5,6 Meal replacement programs are also effective for weight loss and

Chapter 5 - Green Tea Weight Loss Pills 19 Chapter 6 - A Study On The Effect Of Green Tea On Weight Loss 26 Chapter 7 - The "Green Tea" Diet 28 Chapter 8 - Conclusion 40 . Green Tea: An All-Natural Weight Loss Solution That Works . Microsoft Word - Green Tea - An All-Natural Weight Loss Solution That Works.doc

Non-Surgical Weight Loss 7-10% weight loss is the target for lifestyle interventions Losing weight is hard keeping it off is harder! Non-Surgical Weight Loss 7-10% weight loss is the target for lifestyle interventions Losing weight is hard keeping it off is harder! 0 11 22 33 44 12 24 36 48 Exercise Diet Diet/Exercise .

Solutions: AMC Prep for ACHS: Counting and Probability ACHS Math Competition Team 5 Jan 2009. Problem 1 What is the probability that a randomly drawn positive factor of 60 is less than 7? Problem 1 What is the probability that a randomly drawn positive factor of 60 is less than 7? The factors of 60 are 1,2,3,4,5,6,10,12,15,20,30, and 60. Six of the twelve factors are less than 7, so the .