Obesity Your MOVE TIME Bariatric TEAM!

• Medicine • Bariatric Surgeons • Behavioral Medicine/Psychologists • • Physical Therapists • Nursing and Clerical staff

Goals of the MOVE TIME Clinic

• To help you lose weight, live a healthy lifestyle and improve your quality of life – Medical management to help those not interested in or not surgical candidate – Medically optimize obesity-related comorbid conditions – Surgical management for those interested in weight-loss surgery Medical Evaluation: What do we do?

• Evaluate causes of obesity • Evaluate/treat obesity-related conditions • Offer medical treatments for obesity – • Pre-operative evaluation • Post-operative care Common Causes of Obesity

• Inactivity- computer, gaming, TV time, commuting, desk work • Excess caloric intake- large portions, liquid calories (alcohol/sodas), unhealthy choices

Medical Causes of Obesity

• Untreated Apnea (OSA) • Insomnia/Poor sleep • Hormone related- , Polycystic Ovarian Syndrome, Low Testosterone, Cushings • , anxiety, PTSD, sexual trauma, stress • Medications- e.g. psychiatric medications, for • Genetics/ • Traumatic Brain Injuries

Medical conditions related to Obesity

• Diabetes • Failure • High Blood Pressure • Kidney • High Cholesterol • • • Blood Clots • Heart Burn/Reflux • • Joint • pain/ • • Fatty liver and • Hormone Abnormalities Treatment of Obesity Treatment of Obesity

• Improve • Improve • Behavioral/Psychological • Optimize obesity-related conditions • Weight loss medications • Limit medications that cause • Weight-loss surgery ()

Treatment of Obesity

Optimize obesity-related conditions • Glucose control for Diabetics (goal A1c <7) • Control blood pressure (<140/90) • Treat high cholesterol • Evaluate for heart disease • Manage chronic pain • Treat Treatment of Obesity

Limit medications causing weight gain • Psychiatric Medications • Insulin/glipizide/glyburide • Gabapentin • Steroids (prednisone) • Antihistamines (benadryl) • Many other medications!

Treatment of Obesity

Using Weight-Loss Medications • Requires careful evaluation and coordination with your MOVETIME provider to determine if these medications are right for you • Can provide up to 5-10% weight loss when combined with and

Treatment of Obesity

Available Weight Loss Medications at the VA • (Alli or Xenical) • (Belviq) • • Phentermine/Topiramate (Qsymia) • (Saxenda) • Buproprion/ (Contrave) • (for binge ) Bariatric (Weight Loss) Surgery How does Bariatric Surgery work?

• Bariatric Surgery is a TOOL to promote weight loss • Restricts the amount of food you can eat • Causes metabolic and hormonal changes – Improves diabetes almost immediately – Decreases and promotes fullness Pre-Surgical Evaluation

• Age appropriate • MOVE Participation screening • Healthy Diet/Exercise – Colonoscopy • If Indicated: – Mammogram – Cardiac evaluation – Pap smear – Sleep apnea • Endoscopy (EGD) evaluation • Blood and Urine Tests – Pulmonary Function • Psychological Tests Evaluation Post-Surgical Follow Up

• 1 week Telephone visit • 2 weeks Surgery clinic visit • 2 months MOVE TIME clinic visit • 6 months MOVE TIME clinic visit • 1 year visit and then yearly with MOVE TIME clinic MOVE TIME clinic follow-up is important!

• Review laboratory testing for possible vitamin or mineral deficiencies • Adjust medications for chronic conditions – (ie. Diabetes, High Blood Pressure, etc.) • Recommend CPAP adjustment or sleep studies • Vitamin supplementation – Multivitamin With Iron 200% RDA – Calcium Citrate 1200-1500mg/day – 1000-3000 units/day – B12 monthly injections/daily pill if Gastric Bypass – May need additional supplements

Medical Benefits of Surgery

• Diabetes- improves immediately! • High blood pressure improves • Decreases diuretic needs • Decreases cholesterol • Improves sleep apnea • Improves joint pain and mobility • Improves fatty liver • Decreases cancer risk • Decreases the risk of dying from obesity

Medical Benefits…Continued

• Improves and sexual function – Men: increases testosterone – Women: • Those of child bearing age should avoid for 12-18 months after surgery • Following Gastric Bypass women may need contraception other than “the pill” • Following Gastric Bypass emergency contraception may not work • We will discuss these changes with you

Medical Issues following Surgery

If there are difficulties after surgery then we will help you manage them!

• Vitamin Deficiencies • Acid Reflux • Low blood glucose • Alcohol problems • Low blood pressure • Mental Health Issues • Kidney stones, • Absorption • flares changes • Hair loss, excess skin • Constipation • Bone thinning • Dumping syndrome • Taste/Food tolerance changes Obesity Medicine at the Palo Alto VA

• We want to help you and we look forward to seeing you in the MOVE TIME Clinic!

• Ask your primary care provider to refer you to MOVE TIME if you are interested in beginning the evaluation for Bariatric Surgery!