Pre and Post Natal Care Challenges with Obese Patients

BRAD THAEMERT, MD FACSSURGICAL INSTITUTE OF SOUTH DAKOTA, PC

Agenda

Obesity awareness

Value of bariatric surgery

Review of bariatric surgeries Surgical and non-surgical options

Nutritional deficiency

Obesity Awareness Obesity is THE

major public health concern. Greater than heart

disease, smoking, etc.

Finally widely recognized as a disease in 2013

Excess fat contributes to chronic health conditions.

Category BMI Range

Normal Weight 18.9 to 24.9

Overweight 25 to 29.9

Class I, Obesity 30 to 34.9

Class II, Serious Obesity 35 to 39.9

Class III, Severe Obesity 40 and greater

BMI (Body Mass Index): a measure of body fat calculated using a person’s height and weight

Body Mass Index

Women of reproductive age in the US: 30.2% obese56.7% overweight

Obesity rates in the adult female population:Race Obesity RateNon-Hispanic/African-American 48.8%Hispanic 38.9%Non-Hispanic/Caucasian 31.3%

Obesity in America

Obesity in Pregnancy

Mother’s BMI Recommended Weight Gain During Pregnancy

Normal (BMI 18.9 to 24.9) 25-35 lbs.

Overweight (BMI 25-29.9) 15-25 lbs.

Obese (BMI 30+) 15 lbs.

Risks of short and long term complications for mother and fetus.

Affects metabolic and hormonal environment of developing fetus.

Possibly changes structures in the brain that regulate appetite and metabolism, affecting person lifelong.

Obesity in children increased 11% from 1994 to 2000.

Source: The Impact of Maternal Obesity on Maternal and Fetal Health, Meaghan A Leddy, Michael L Power, Jay SchulkinRev Obstet Gynecol. 2008 Fall; 1(4): 170–178, PMCID: PMC2621047

Source: The Impact of Maternal Obesity on Maternal and Fetal Health, Meaghan A Leddy, Michael L Power, Jay SchulkinRev Obstet Gynecol. 2008 Fall; 1(4): 170–178, PMCID: PMC2621047

Nutritional Deficiencies

Vitamin % of Patients DeficientThiamin 15-29%B12 2-18%

Folate 54%Iron 45%Vitamin A 7%Vitamin D 60-70%

Pre Weight Loss Surgery

Weight Loss Options

Method Success Diet & Exercise Poor Meds Poor Hypnosis Poor Non Surgical Procedure Good Surgical Procedure Excellent

Value of Bariatric Surgery Bariatric surgery is the most

effective treatment for morbidly obese patients.

Bariatric surgery is a metabolic surgery and improves or resolves many comorbid conditions.

Clinical evidence shows that the risks of being morbidly obese outweigh the risks of surgery.

Comorbidity ResolutionProcedure HTN Diabetes Hyperlipidemia Sleep

ApneaGERD

Sleeve Gastrectomy 65% 60% 75% 60% 75%

Roux-en-Y Gastric Bypass 75% 80% 85% 75% 95%

Procedure % Excess Weight Loss % Total Weight Loss

Sleeve Gastrectomy 65% 30%

Roux-en-Y Gastric Bypass 75% 35%

Outcomes at 2 Years

Surgical OptionsSleeve GastrectomyRoux-en-Y Gastric BypassGastric Band/Lap Band

Non-Surgical OptionsORBERA Intragastric BalloonEndoscopic Sleeve Gastroplasty (ESG)

Sleeve Gastrectomy

Gastric Bypass

Lap Band

ORBERA Balloon

Endoscopic Sleeve Gastroplasty

SummaryObesity prevalence increasing

with significant risk to mother and fetus.

Consider weight loss eval pre-pregnancy.

Beware of vitamin/mineral deficiencies in obese females prior to pregnancy.