Weight Center Program Orientation

Program Orientation

UMass Memorial: Best Choice in Weight Loss Surgery!

UMass Memorial Weight Center is one of the top bariatric surgery programs in our region and provides a patient-focused approach to help adults struggling with obesity and weight-related diseases.

Our center is accredited by the American College of Surgeons as a Comprehensive Bariatric Center – recognized for high standards of quality and is approved to perform all procedure types.

UMass Memorial: Why Choose Bariatric Surgery?

Our weight loss program offers a patient-focused, multidisciplinary approach aimed at promoting:

 Permanent & long-term weight loss

 Improved quality of life

 Increased life expectancy

 Improved medical issues

IS SURGERY AN OPTION FOR ME?

• United States National Institutes of Health (NIH) sets guidelines

• Body mass index (BMI) over 40 or over 35 with diabetes, high blood pressure, sleep apnea, or certain other weight-related medical problems

• Height and weight are measured in the clinic for accuracy

• Initial medical history is gathered with a pre-appointment phone call and reviewed with the medical provider at your first appointment

UMass Memorial: Public & Private Insurance Coverage

• Know your insurance requirements!

• Most require at least 6 months of preparation for bariatric surgery, with some requiring consecutive appointments

• Some require specific lab testing, follow-up or clearances

• If insurance changes during program, call to verify bariatric benefits

Insurance requirement examples:

• Aetna: 12 total visits prior to surgery

• Masshealth: at least 4 months of consecutive visits

• Harvard Pilgrim: at least 6 months of appointments

• Cigna, Unicare, Aetna, Harvard Pilgrim, Fallon: require a visit with an exercise physiologist

UMass Memorial: Monthly Weight Center

Appointments

Our program is designed to offer monthly appointments that build on each other as you prepare for bariatric surgery:

• Typical pre-op preparation time is 6 months

• Spending 6 months in preparation for surgery will help you have the best possible outcome with weight loss and improved health

• Some people spend longer than 6 months preparing for surgery

GASTRIC BYPASS OR SLEEVE GASTRECTOMY

Which surgery is right for you?

GASTRIC BYPASS VS. SLEEVE GASTRECTOMY POSSIBLE CONSIDERATIONS

Gastric bypass:

 Higher starting BMI

 May be more effective than sleeve in moderate to severe type 2 diabetes

 Nutritional deficiencies can be more common

Sleeve gastrectomy:

 Lower BMI though heavier patients have been successful

 Ulcer risk lower than bypass in patients who take anti-inflammatory medication including steroids

 Absorption issues with certain medications less of a concern than with bypass

 May worsen reflux symptoms in those who already have severe reflux

GASTRIC BYPASS SURGERY

 First performed 1967

 Almost always done laparoscopically

 Nothing is removed

 Flow of food is different after surgery

SLEEVE GASTRECTOMY

 Safety and results excellent

 Not as much long-term information as with bypass, but good medium-term data on safety and outcomes

 Weight loss/ impact on health may not be as good as bypass for some patients

 Has fewer long-term risks than bypass

 Concern about certain medications is less than with bypass

WEIGHT LOSS COMPARISONS

 Most gastric bypass patients lose 65-70% of excess body weight within two years of surgery and keep off 55-60% at ten years

 Weight loss results with sleeve appear to average about 5% less than bypass

WEIGHT LOSS FACTS

 Weight loss varies person-to-person

 Lowest weights usually reached 1-2 years after surgery

 Some weight regain is common after reaching lowest weight

 Avoiding weight regain depends on permanently sticking with new diet and exercise habits

HOSPITAL STAY AND TIME OUT OF WORK

 Gastric bypass and sleeve

gastrectomy patients:

– Usually spend one night in hospital

– Upwards of 4-6 weeks out of work

 Surgeries are performed at our Memorial Campus

UMass Memorial Medical Center- Memorial Campus

WEIGHT LOSS SURGERY COMPLICATIONS

 Risks are higher for older, heavier, and more medically complicated patients

 Risks are decreased by losing weight before surgery

 If you have questions about risks and complications, ask your weight center providers

COMPLICATIONS THAT CAN OCCUR

AROUND THE TIME OF SURGERY

SLEEVE

Rare: Less than 1%

Obstruction/blockage

Injury to organs

Anesthesia problems

Blood clots

Death

BYPASS

Rare: Less than 1%

Obstruction/blockage

Leak

Injury to organs

Anesthesia problems

Blood clots

Death



COMPLICATIONS THAT CAN OCCUR WEEKS, MONTHS, OR YEARS AFTER SURGERY

CARE AFTER WEIGHT LOSS SURGERY

 Physician available 24/7 for emergencies

 Surgical follow up at 2 and 6 weeks, 6 months, 1 year, then yearly if desired

 Nutrition follow up at 3 weeks, 3 months, 9 months, then yearly if desired

 Online support groups, online discussion group, exercise program and yearly nutrition follow up offered if desired

Care Team

WEIGHT CENTER SURGEONS

John J. Kelly, MD

Donald Czerniach, MD

Philip Cohen, MD

Nicole Cherng, MD

Richard Perugini, MD

Obesity Medicine Specialists

Mitchell Gitkind, MD

Elizabeth Benjevin, MD

WEIGHT CENTER SUPPORT TEAM

Nurse Practitioners: Robin Mason, Terese Holm, Kayla Furr, Erin Owens

Physician Assistants: Ann Clark, Melissa Potter

Dietitians: Caitlyn Leavitt, Justine Nash, Ashley Denning

Behavioral Health Specialists: Jennifer Lauretti, Rachael

Measer

Exercise physiologist: Janet Huehls

Program Coordinator: Anna Grotevant

Program Navigator: Tiffani Lehto

UMASS MEMORIAL IS AN ACADEMIC INSTITUTION

 Residents and fellows involved in patient care

 Research into causes of and treatments for weight problems

 Training center for surgeons

Preparation Steps

UMass Memorial: Testing, Lab Work, and Clearances

Medical Intake

 A medical doctor or nurse practitioner will review your medical and surgical history

 They may recommend additional testing or lab work – get this done as soon as possible

 Some medical problems could delay surgery until they are treated:

 Uncontrolled diabetes with an A1c over 9.5%

 Advanced liver disease

 Untreated sleep apnea

UMass Memorial: Testing, Lab Work, and Clearances

Behavioral Health Intake

 A psychologist or social worker will evaluate your mental health history, social history and support system

 We may request feedback from an outside provider if you have one

 Some conditions or situations could require more support or monitoring:

 Smoking cigarettes

 Current use of illegal drugs or excessive alcohol intake

 Untreated psychiatric illness

 Unstable housing

UMass Memorial: Testing, Lab Work, and Clearances

Nutritional Health

 Adherence to recommendations made by the nutrition team

 Adopting healthy and sustainable practices

 Weight loss throughout the program or maintenance

Group Education Classes

Initial Nutrition Group (Month 1-2)

– Focuses on diet and lifestyle changes before surgery

• Nutrition Surgery Skills Group (Month 4-5)

– Focuses on diet the first few weeks after surgery

• Medical Surgery Skills Group (Month 4-5)

– What to expect from a medical standpoint directly after surgery

• Post-op diet advancement group (3 weeks after surgery)

–

Focuses on transitioning from a mostly liquid diet to a solid food diet

Patients who are unable to access MyChart/Zoom may be scheduled for in person, 1-on-1 visits for these educational sessions

Sign Up for MyChart

Sign Up & Simplify the Weight Center with MyChart!

Step 1: Give your e-mail address & ask for an activation e-mail to be sent to you. Anyone can send this to you (Weight Center, Central Scheduling or 855-UMASS-MD)

Step 2: From the activation e-mail, create your MyChart account by entering: 6-character username, 8-character password, & Date of Birth

Step 3: Download Zoom to access Telehealth

Step 4: Begin enjoying!

Please Note: If you prefer telehealth visits, you must use MyChart

In Person vs. Telehealth Visits

UMass Memorial: In-Person Visits

Complete (Pre) Check-In

• Remember to complete pre-check on MyChart 1-3 days prior to visit

Arrive Early

• Patients should arrive 20 minutes before their visit to park, check in and complete paperwork

Weight Check

• Patients will be weighed at their visit and documented throughout program.

Check-Out

• Prior to leaving, make sure to schedule your next visit. If you forget, call as soon as possible!

UMass Memorial: Telehealth Visits

Complete (Pre) Check-In

• Remember to complete pre-check on MyChart 1-3 days prior to visit

Know How to Connect for Visit

• MyChart/Zoom

• Telephone

Weight Check

• Patients must weigh themselves before start of telehealth visit.

Check-Out

• You will receive an appointment 1-2 days after your visit. If you have not heard from us, call the clinic!

UMass Memorial: Virtual Groups

DO NOT ACCESS THROUGH MYCHART

Expect an Email

• May receive 1-3 days prior to visit Join 15-20 Minutes Before

• Please join 15-20 minutes prior for check-in

• Troubleshoot Audio/Video

Joining Late/Connection Issues

• Anyone joining the meeting > 5 minutes will not be (re)admitted

UMass Memorial: Telehealth Visit

Requirements

• Secure, private location

• Reliable internet connection

• Cannot be operating a vehicle

• Camera must be on for individual visits

• Patients may be muted and shut off their video for group visits

Providers may request to reschedule a visit if these requirements are not being met

UMass Memorial: Patient Support Groups

Provider & Patient-led: Facebook, Nutrition, and Exercise

• Support groups currently offered via telehealth

• Online support offered via our private Facebook group

• Receive reminders and links by joining our Facebook group or signing up for our mailing list

Join our Facebook group by searching for our name on Facebook and requesting to join: UMass Memorial Weight Center Bariatric Surgery Support Group

UMass Memorial: Free Exercise Physiology Sessions

This is a benefit offered to all pre-op patients and is included free of charge for patients pursuing bariatric surgery:

• Learn how to make exercise enjoyable, effective, and time efficient

• Helps with weight loss before and after surgery!

• Begin anytime!

Janet Huehls, MS

Clinical Exercise Physiologist Certified Health Coach

Online exercise program

◦ Created just for Weight Center patients

◦ Access any time online

◦ Learn how to exercise

◦ Modifications for pain

◦ Flexible for limited

◦ Exercise at home or gym

◦ Once a week for 30 min

◦ Support before and after surgery

◦

More info about exercise in each phase