Health Assessment Guide for Patients with

There is an ever increasing number of people with weight issues, and more specifically, Adiposity Based Chronic Disease (ABCD). Patients with a BMI of 30 or greater are considered to be suffering from the disease of obesity. Obesity has been recognized as a metabolic disease by the American Medical Association and patients should receive treatment just as they would for any other disease. It is vitally important to understand the science of obesity and its treatment options. This guide provides helpful information and resources to treat this condition.

Body Mass Index (BMI) Causes of Obesity The (BMI) is a measurement tool that Obesity is a complex compares height to weight and provides an indication of health issue that is whether an individual is or obese. caused by a variety of factors.

How to calculate your BMI

WEIGHT X 703 (HEIGHT IN INCHES)2

Underweight BMI: <18.5 Obesity Related Conditions Healthy Weight Many people that are overweight, or obese, have significant BMI: 18.5 - 24.9 other health conditions that are either caused by or affected Overweight by their condition. BMI: 25 - 29.9 Patient’s conditions affected or caused by excess Class I Obesity weight – check all that apply. BMI: 30 - 34.9 Class II Obesity Type 2 Mellitus Obstructive BMI: 35 - 39.9 Class III Obesity Urinary Stress Incontinence BMI: ≥40 Migraines Hypercholesterolemia /Degenerative Other______Joint Disease Tools and Resources ______Considering can be overwhelming. The Asthma Metabolic and Bariatric Surgery Program is here to provide the ______support and resources you need to make an informed decision.

Visit fresnobariatrics.org or call 866-433-8558 to learn more! Efforts Please complete the information below and return to There are important hormonal [email protected] or fax 559-261-4501. changes associated with weight loss attempts that & ______affect long-term success. Increased to Reduce PATIENT NAME Appetite/ Weight loss with diet and Slowing of Weight exercise alone is challenging Metabolism ______because the body fights to DATE OF BIRTH Hormone Levels maintain its current weight. Adjust to Promote Weight Retention ______PHONE 00099 Health improvements associated with weight loss, Treatment Options particularly from bariatric surgery Depending on a patient's BMI and/or the presence of Surgery has strong results – short and long term, for reducing obesity-related diseases, there are currently four groups weight as well as reducing and/or resolving obesity-related of treatment options for obese patients. On the lines diseases such as Mellitus. below, list previous weight loss attempts and indicate how much weight was lost and for how long: IMPORTANT SAFETY INFORMATION: There are risks with any surgery, such as adverse reactions to medications, problems with , problems breathing, bleeding, blood clots, inadvertent injury to nearby organs and blood vessels, even . Bariatric surgery ______has its own risks, including failure to lose weight, nutritional or vitamin deficiencies, and weight regain. Patients should consult their physicians to determine if this procedure is appropriate for their condition. ______

Treatment options 1 Migraines Lifestyle Modification 46% improved 12 Medication Therapy 2 Depression (with obesity-related 47% reduced 13 diseases) Medication Therapy 3 Pseudotumor cerebri (without obesity- 1 96% resolution of related diseases) 2 headaches 14 95% resolution of Endoscopic 4 3 pulsatile tinnitus 14 Treatment Minimally Invasive 4 Surgery 45% to 76% resolved 15, 26 (with obesity-related diseases) 5 5 High cholesterol Minimally Invasive 71% to 94% improved 17* 7 6 Surgery (without obesity- 6 Asthma related diseases) BMI 8 39% resolved 18 9 20 30 40 50 10 7 High blood pressure 42% to 66% resolved 18, 19, 26 Lifestyle Modification Minimally Invasive Surgery

11 BMI ≥ 25-29.9 BMI 35 8 Nonalcoholic fatty ≥ 12 liver disease Diet - establish a healthy eating pattern with obesity-related diseases 37% resolution of 20 and attainment of individualized BMI ≥ 40 glycemic, blood pressure and lipid goals without obesity-related diseases Exercise - breakup continuous sitting 80% resolved 20 time over 90 minutes - Gastric Bypass - procedure where the stomach is divided into a small 14 9 Gastro Esophageal Reflux Medication Therapy upper pouch and much larger lower 13 Disorder - GERD % % 13, 21 72 to 95 resolved BMI ≥ 30-34.0 “remnant” pouch. with obesity- related diseases - - removes approx. 10 Type 2 diabetes Mellitus Sleeve Gastrectomy 49% to 51% resolved 22, 5 BMI ≥ 35-39.9 80% stomach, restricting the amount of without obesity-related diseases food that can be consumed. 11 Polycystic ovarian syndrome 52% resolution of hirsutism 23 - Phentermine, Lorcaserin, Phentermine, - Bilopancreatic Diversion with Duodenal % 100 resolution of Topiramate ER and Naltrexone-Burpion Switch (BPS/DS) - a small tubular 23 menstrual dysfunction stomach pouch is created by removing a Endoscopic Treatment portion of the stomach, then a large 12 Urinary stress incontinence 50% resolved 24 BMI ≥ 30-35 portion of the small intestine is bypassed. - Endoscopc Sleeve - A non- *Figure is for hyperlipidemia. 13 Venous stasis disease *All minimally invasive surgery options above % permanent plication of the stomach Hyperlipidemia is a general term for high fats 95 resolution of venous suppress and prolong fullness. in blood, which may include cholesterol and/ stasis ulcers 25 reducing the size of the stomach. or triglycerides. Resolution observed in the context of studies. EES has no independent 14 Osteoarthritis/degenerative data to suggest permanent resolution. joint disease 41% resolved 13 For a full list of references please visit: https://communitymedical.org/CMC/media/FHSH/Documents/Health_Assessment_Guide.pdf

Fresno Heart & Surgical Hospital Metabolic & Bariatric Surgery Program 15 E. Audubon Drive FresnoBariatrics.org Fresno, CA 93720 (866) 433-8558