Bariatric Care Center

Surgical Weight Management

summahealth.org/weightloss Contents

Program Overview

Obesity 4

Weight Loss Surgery - 4 Easy Steps 5

Surgical Options 8

Our Multidisciplinary Team 10

Quality of Care 12

Cost of Surgery 14

Education and Support 15

Clinical Excellence 16

Frequently Asked Questions 18 Summa’s Bariatric Care Center wants to help you make a change

Program Overview It is no secret that a growing number of Summa’s Bariatric Care Center people in this country are , wants to help you make a change. obese or morbidly obese. While no one fully understands the exact cause of Our program’s comprehensive, , we do know that: team-based approach to weight • The causes of obesity are multi- loss management focuses on your factorial and include food choices, individual needs – and provides you lifestyle and genetics. with the support and tools you need • Obesity is a complex that to achieve your goals. requires a high degree of skill and knowledge to effectively manage. • Obesity is a very personal and sensitive condition that requires the care of an attentive and compassionate team.

“I used to be very limited, but now I can do anything.”

Gary Jentes, Weight Loss Surgery Patient

3 Obesity

Obesity is a disease of excess Obstructive weight. It is classified as a Obstructive sleep apnea is a chronic disease by the American condition where the airway Medical Association, one that collapses while a patient is sleeping, requires medical treatment and cutting off the supply of oxygen to the body. Patients with this condition are prevention. required to sleep attached to a machine that keeps the airway open by forcing It is defined based upon body mass air into the trachea (airway). index (BMI), which describes a relationship between weight and height. Surgery is indicated for patients Hypertension (high blood pressure) is a with a BMI greater than or equal to 40 condition where the heart has to work kg/m², or a BMI greater than or equal to harder to pump blood through the 35 kg/m² with at least one co-morbid overweight body. It is a risk factor for disease caused by the obesity. other serious such as stroke, heart attack and kidney failure. Many patients require medications to control To calculate your BMI, go their blood pressure. to summahealth.org/BMI Gastroesophageal Reflux Disease GERD (heartburn/acid reflux disease) is Obesity’s Impact On Health a condition where increased pressure Scientific evidence shows that on the stomach causes its contents being obese or overweight is a to rise up into the esophagus, often significant risk factor for several causing significant irritation and pain. serious diseases, including: Patients with GERD often need to take medications to reduce the amount of Type 2 acid produced in the stomach. Diabetes is a serious disease that increases your risk of developing Studies show that patients who . It damages lose a significant amount of the blood vessels throughout the weight usually experience a body, which can result in poor dramatic improvement or even circulation, amputations, blindness, a cure of these conditions. They kidney disease, stroke, heart attack can often reduce or eliminate and peripheral artery disease. the need for medications and/ Patients with diabetes often have to take insulin or other medications to or machines to help breathing control their blood sugar levels. during sleep.

4 Bariatric Care Center “I used to feel imprisoned by my health. Now I feel liberated.”

Jim Sommers, Weight Loss Surgery Patient

Weight Loss Surgery — 4 Easy Steps

Step 1: Contact the Bariatric Step 2: Attend Introductory Visit Care Center For your Introductory Visit, you will Summa Health's Bariatric Care Center come to the Weight Management welcomes your interest in our Surgical Classroom, which is located here: Weight Management program.

Call the Bariatric Care Center at Perkins St N 330.375.6590. During this phone N 8 conversation, we will: • Provide more details about our Arch St Hamlin Pavilion process one way 95 Arch Street Forge St

• Answer any questions you may have Cooper P Pavilion

• Discuss insurance options Fountain St — • Schedule your introductory visit

— Goodkirk St 75 Arch St (Step 2) Summa Health Upson St

one way Akron

• Explain the requirement for viewing Campus 55 Arch Street our weight loss surgery patient Adolph St

education seminar and attendance Adams St options East Market St

Summa Health System — Akron Campus We strongly encourage you to contact Summa Health Richard M. and Yvonne your insurance company prior to this Hamlin Pavilion call to determine if you have the weight 95 Arch St, 1st Fl loss surgery benefit on your plan. (follow signs to the classroom) Akron, OH 44304

Surgical Weight Management 5 (Step 2 continued) • John Zografakis, M.D., FACS, FASMBS During this visit you will complete Director documentation needed for your surgical • Adrian Dan, M.D., FACS, FASMBS Director evaluation and we will verify your insurance benefits. As long as there are • Mark Pozsgay, D.O., FASMBS Program Surgeon no issues with your insurance, you have completed the seminar requirement and you are able to complete all of the A member of our staff will also be on requested forms, you should leave your hand to answer your questions about introductory visit with the date and time our comprehensive program, which of your surgical evaluation. includes: • An individualized evaluation of each patient All patients are required to view our • A standardized approach to surgery weight loss surgery patient education and post-operative care seminar before scheduling a one-on- • Ongoing and life-long follow-up and one evaluation with a surgeon. You can support participate in a seminar in one of two • Compassionate and personalized ways: care

Online Seminar If you are NOT a current patient of Summa’s Weight Loss Surgery Online Summa Health's Bariatric Care Seminar is a taped version of an in- Center you can reserve your seat person seminar conducted by Summa for the in-person seminar or view Health's Bariatric Care Center. the online version by visiting summahealth.org/seminar. At the end of the online weight loss surgery seminar video, you will be Note: If you choose to watch the online asked to click a link which will take you video, you do not need to attend a live to an online form. Please complete the weight loss surgery seminar. form with the information requested. If you do not fill out the form, you will need to either view the seminar again Step 3: Complete Surgical or attend a live seminar. Evaluation During this visit you will meet one-on- In-Person Seminar one with the surgeon for an evaluation. Attend a seminar and meet one of This is your opportunity to ask clinical Summa Health System’s fellowship questions. Summa’s bariatric surgeons trained bariatric surgeons. are boardcertified in general surgery and fellowship trained in advanced laparoscopic and .

6 Bariatric Care Center The team has completed more than Following enrollment: 3,000 minimally invasive weight loss • An initial scheduling packet will be surgeries with excellent outcomes. prepared for you based upon your surgeon’s orders.

Your surgeon will: • You will undergo a series of tests and assessments, as ordered by your • Review your medical history and surgeon based upon your medical determine whether surgery is an history and the requirements of your option for you insurance company. • Explain the types of surgical • You may need to complete monthly procedures available physician-supervised and • Help you decide which procedure is visits if required by your the best choice for you insurance. If so, these will be • Answer any clinical questions that scheduled for you. you have about weight loss surgery • Our interdisciplinary team will meet during the pre-operative process to review your progress. The team assesses whether special instruction, Step 4: Program Enrollment clarification, or additional support Once you have completed the initial is needed. The recommendations evaluation and have been cleared by of the team are forwarded to your your surgeon to proceed with pre- surgeon, who makes the final operative testing, you are ready to decision about your eligibility and readiness for surgery. enroll in the program. You may be able to enroll on the date of your surgical evaluation.

“Since my surgery, my life is happier; I am happier with myself.”

Lisa Mark, Weight Loss Surgery Patient 7 Surgical Options

Laparoscopic Roux-en-Y Gastric Bypass With more than 200,000 performed annually in the United States, the Laparoscopic Roux-en-Y Gastric Bypass is the most frequently used and successful procedure to manage obesity. During surgery, the normal anatomy of the stomach and is altered to restrict the size of the stomach and limit absorption. This results in eating less food and the body Laparoscopic Roux-en-Y Gastric Bypass absorbing only a portion of that food.

Laparoscopic Sleeve Gastrectomy Laparoscopic Sleeve Gastrectomy is a minimally invasive procedure that involves dividing the stomach into two separate parts. The portion of the stomach through which food passes is shaped like a tube, or a sleeve. This results in the stomach no longer being able to hold a large portion of food, therefore patients eat less while feeling full. Food digestion occurs through the normal process, so and vitamins from food can be fully

absorbed into the body. Laparoscopic Sleeve Gastrectomy

Laparoscopic Revisional Surgery Laparoscopic Revisional Surgery is available to patients who have already undergone a primary weight loss surgery procedure. These procedures are for patients who have experienced complications from their initial surgery.

8 Bariatric Care Center At Summa, our primary focus is laparoscopic (or minimally invasive) surgery. In some instances, an open procedure may be required – an option our program offers, if needed.

Advantages of the minimally invasive approach include: • decreased incisional pain • decreased chance of wound infection • shorter hospital stay • more rapid recovery • faster return to work

Surgical Weight Management 9 Our Multidisciplinary Team

Surgeons Physician

John Zografakis, Adrian Dan, Mark Pozsgay, Ken Wells, M.D., M.D., FACS, FASMBS M.D., FACS, FASMBS D.O., FASMBS Certified Diplomate ABOM Director, Bariatric Director, Bariatric Bariatric Program Medical Director, Care Center Care Center Surgeon Nonsurgical Weight Management Program

Clinical Psychologists Nurse Practitioner

Jennifer Duncan, Psy.D. Christina Rummell, Ph.D. Leisa Bridle, NP

Registered Nurses Registered Dietitians

Barb Norvaisa, Debbie Pasini, Hanna Koscinski, Tess Lockhart, BSN, RN BSN, RN, CBN RDN, LD RD, LD

Clinical Exercise Specialist Financial Specialist

Laura Richardson, RCEP Bev Hendrickson

10 Bariatric Care Center Surgeons Registered Dietitians Our surgeons are board certified in Our dietitians work closely with each general surgery and have completed patient before and after surgery to a full year of fellowship training in provide education regarding pre and advanced laparoscopic and weight post-operative diet changes and loss surgery. vitamin supplementation.

Physician Clinical Exercise Specialist Our board-certified internist Our clinical exercise specialist is specializes in and certified by the American College of provides pre-op physician-supervised Sports Medicine (ACSM). She provides diet and exercise for patients who training that explains the role that need this service to meet their exercise plays in successful weight loss. insurance program’s requirements. She also helps each patient develop He also provides long term weight an individualized exercise plan and is management follow up after surgery. available for individual consultation.

Clinical Psychologists Financial Specialist Our Bariatric Program psychologists Our financial specialist explains the provide pre-operative evaluation of details of your medical insurance, all patients and both pre and post- reviews with you all known out-of- operative evaluation, counseling, and pocket expenses (those that are not support to those patients who need it. covered by insurance) and works closely with you and your insurance Nurse Practitioner company to obtain approval for Our nurse practitioner works closely surgery. with our surgeons and physicians to provide comprehensive pre and post- operative care to our patients.

Registered Nurse (RN) Case Managers Our case managers provide intensive education and support before, during and after surgery. They work closely with our surgeons to ensure each patient receives excellent care.

Surgical Weight Loss Management 11 Quality of Care

Summa’s Bariatric Care Center is dedicated to excellence in minimally invasive weight loss surgery and its associated outcomes. Summa’s outcomes statistics meet or exceed those of other hospital program outcomes across the country.

30-day Mortality Summa’s Bariatric Care National Procedure Center Percentage Percentage* Roux en Y Gastric 0.00% 0.20% Bypass

Sleeve Gastrectomy 0.00% 0.10%

Average Length of Stay Summa’s Bariatric Care National Average Procedure Center Number of Days Number of Days* Roux en Y Gastric 2.40 2.40 Bypass

Sleeve Gastrectomy 1.60 2.0

Summa’s Proven Results Following weight loss surgery, patients experienced improvement in these comorbid conditions at five years: • 71% have resolution and/or improvement of their • 58% of patients have resolution and/or improvement of their hypertension • 79% have resolution of their obstructive sleep apnea • 59% have resolution of their gastroesophageal reflux disease

12 Bariatric Care Center “I was on multiple medications and suffering from type 2 diabetes. Now, after my surgery, I’m no longer insulin-dependent.”

Chuck Gough, Weight Loss Surgery Patient

13 Cost of Surgery

Understanding the details of If you do have the benefit, you will medical insurance coverage as it probably be told that you must meet relates to paying for weight loss their medical criteria, which is typical. surgery can be overwhelming. All plans that cover weight loss surgery That’s why our team has a have specific medical requirements full-time financial specialist that must be met in order for the who helps you understand your insurer to pay for weight loss surgery. insurance benefits and out-of- We will ensure that you meet all of pocket financial responsibilities. these requirements before your case is submitted for approval. On the day you meet with your surgeon, you will also meet with a Out-Of-Pocket Expenses member of our financial team who Certain expenses related to the will: surgery are considered “noncovered” • Explain the specifics of your weight by all insurance plans and are your loss surgery insurance benefits responsibility. These non-covered • Review all known out-of-pocket expenses include: expenses with you • Program administration fee • Pre-surgical assessment(s) After you enroll in the program, the • Co-insurances as determined by financial specialist works closely your insurance company with you throughout the process of • Deductibles as determined by your obtaining predetermination for your insurance company surgery. • Co-payments as determined by your insurance company Insurance Coverage • Pre-operative meal plan All major insurance companies cover weight loss surgery on some of For patients who have medical their benefit plans. However, not all insurance plans which do not cover employers select this benefit for their weight loss surgery, we offer a private employees. We recommend calling the pay program for the Roux-en- number on your insurance card to ask: y gastric bypass and the Sleeve Gastrectomy. The details of this “Do I have the weight loss surgery program can be discussed with benefit on my plan?” the financial specialist during your first meeting. Patients must have You should receive a simple “yes/ comprehensive health insurance to be no” answer from your insurance plan eligible for the private pay program. provider.

14 Your Responsibility The financial specialist works closely with you every step of the way, but it is your responsibility to: • Keep us informed of all details of your insurance plan • Communicate directly with your insurance plan about co-payments, co-insurances and deductibles • Inform us immediately of changes in your insurance

Education and Support

Patient Education We offer a monthly patient support Part of our collaborative team approach group that provides an opportunity includes making you (the patient) a for pre and post-operative patients partner in your treatment. to receive additional education and We believe the most successful patients to network with each other for extra are educated and well-prepared support. The group is facilitated by throughout the treatment process. our dietitians. As a result, we place a heavy emphasis on patient education and responsibility. A typical meeting includes: • A guest speaker on a topic of Patients receive: interest. Past meeting topics have • A pre-operative education class included emotional eating, changes in body image, post weight loss • A pre-operative exercise class body sculpting surgery, exercise and • Individualized education provided nutrition. by the nurse case manager and • Updates and reminders about registered dietitian during the important diet and nutrition issues. inpatient stay • A forum for patients to share their • Education provided by multiple successes with each other, ask members of our team during questions and voice concerns. follow-up visits for your entire life • Monthly support groups that provide education and support for all of our patients All patients are strongly encouraged to regularly Weight Loss Surgery attend support group meetings Support Group for the rest of their lives Making all of the necessary changes following weight loss surgery. after surgery can be challenging. We know it isn’t easy, but you don’t For a list of meeting dates, visit have to do it alone. summahealth.org/weightloss.

Surgical Weight Management 15 Clinical Excellence

Summa’s Bariatric Care Center is designated by the American Society for Metabolic and Bariatric Surgery (ASMBS) as a MBSAQIP Accredited - Comprehensive Center.

(Registered trademark of ASMBS. Used by permission of ASMBS. All rights reserved.)

16 Bariatric Care Center The MBSAQIP Accredited - Comprehensive Team Approach Comprehensive Center Our team includes multiple staff designation is only awarded members throughout Summa who to surgical programs that: work closely with our surgeons. Our • Successfully undergo a rigorous surgeons use minimally invasive surgery site survey to verify compliance to provide patients with the safest and with a set of nationally recognized most effective surgical weight loss standards and requirements. procedures. Our weight management • Demonstrate a comprehensive team uses their experience, skill and commitment to a high level of care. compassion to work closely with you in preparation for surgery, to answer all • Submit information for inclusion in of your questions, to help you conquer the largest repository of dedicated your fears and to assist you in reaching weight loss surgery patient statistical your weight loss goals. data in the world. • Measure and report surgical outcomes which are deemed favorable by the ASMBS, an organization dedicated to excellence in surgical outcomes.

Surgical Weight Management 17 Frequently Asked Questions

Q: Why should I choose Summa This can vary depending on Health's Bariatric Care Center? your readiness for surgery, the A: We focus on the individual needs of requirements of your insurance each patient. Our comprehensive company, and the results of the program, comprised of fellowship- testing ordered by your surgeon. trained surgeons, psychologists and You must complete all required an array of highly trained support testing before your surgery can be staff work hard to insure you have scheduled. the best possible outcome. Q: How long will I be off of work? Q: Why is it important to be A: Most patients are off work for four designated a MBSAQIP weeks following a laparoscopic Accredited Center? weight loss procedure. The actual A: As an MBSAQIP Accredited Center, length of time may vary depending Summa meets rigorous program on the type of surgery that you guidelines set by the American undergo, other medical conditions Society for Metabolic & Bariatric that you may have and your Surgery. Being MBSAQIP Accredited individual recovery. Regardless of is a significant distinction among which surgery is performed, heavy surgical weight loss programs that lifting is prohibited for a minimum directly benefits each patient. of one month following surgery. If your job involves lifting objects that Q: Why is it important to have a weigh more than 15 pounds, your fellowship-trained surgeon? time off work may be longer. A: After completing a traditional five-year general surgery residency, Q: How long will I be in the hospital? some surgeons complete an A: The average hospital stay for additional year of surgical training patients undergoing laparoscopic that focuses solely on advanced gastric bypass surgery at Summa laparoscopic and weight loss Health System — Akron Campus. surgery. All ouf our surgeons have is two days. The average hospital trained with renowned leaders stay for patients undergoing in the field of minimally invasive laparoscopic sleeve gastrectomy surgery with a special emphasis on surgery is 1-2 days. weight loss surgery. Q: When will I start to see results Q: How long do I have to wait until following surgery? surgery? A: Patients will begin to lose weight A: The minimum time from immediately following surgery. program enrollment to surgery is Those who closely follow the approximately six months. recommendations of the team can expect to see significant weight loss as soon as six months after surgery.

18 Bariatric Care Center Q: What kind of support will I need at Q: How much weight can I home after surgery? expect to lose? A: During your first week after surgery, A: People who have weight loss you will need someone to assist surgery can expect the following: you. All patients are required to have Following gastric bypass surgery, someone staying with them for their patients will begin to lose weight first week. quickly and will continue to do so during the first 12 months following Q: How often will I see my surgeon surgery. Studies show that post- after surgery? operative patients who choose A: Post-operative visits are scheduled to be compliant with post-op for all patients at one week after recommendations can expect to surgery. After your initial post-op lose 60 to 70% of their excess body visit, you will be scheduled for weight in the first 12 to 18 months appointments at the intervals that following surgery. Studies also show your surgeon orders. The following that patients who continue to follow program guidelines are generally the program can maintain 50 to followed: 60% of their weight loss. • Year One: One month, three months, six months, 12 months Q: How will my weight loss affect my • Year Two: 18 months, 24 months health? • Annually thereafter A: In addition to lower BMI and other health benefits from weight loss, Q: Why is post-operative follow-up so 96% of patients experience an important? improvement in or elimination of A: Success after weight loss surgery is obesity-related health conditions directly related to how closely you such as 2 diabetes, high blood follow your post-operative program. pressure, sleep apnea, reflux This includes diet, exercise and disease (GERD), etc. vitamin supplementation. Because we know that there are numerous Q: Where can I learn more? changes to make and requirements A: You can attend or watch online to follow, we see you frequently our pre-operative patient in our office for follow-up. History education seminar to learn shows that patients who come in for more about your weight loss all scheduled visits and who regularly surgery options. There is also attend monthly support group more information about Summa meetings have the best outcomes. Health's Bariatric Care Center at Once you pass the 12 month point summahealth.org/weightloss. you will follow up for the rest of your life with our Obesity Medicine Specialist.

19 We’re here to help you!

Our weight loss team understands that choosing to lose weight is a life-changing decision that impacts not just you but your family, job and future. We want to help you make the best decision possible.

Call 330.375.6590 or visit summahealth.org/weightloss to learn more.

Summa Health System Akron Campus Bariatric Care Center

Richard M. and Yvonne Hamlin Pavilion 95 Arch St, Suite 260 Akron, OH 44304

BAR-17-28029/CS/KH/4-17/1000