Shared Decision Making Patient Physician A Mutually Acceptable ...

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Table of Contents For the Physician • Put Your Patient’s Mind at Ease • Review the Risks of Morbid Obesity • Reinforce the Health Benefits of Weight Loss • Discuss Your Patient’s Candidacy for Bariatric Surgery • Emphasize the Importance of Behavioral and Psychological Readiness • Explain Bariatric Surgery • Provide the Benefits of Bariatric/Metabolic Surgery • Provide Complication Data • Manage Long-term Expectations • Refer Your Patient to a Center of Excellence Bariatric Surgery Program For the Patient • Feel Good about Your Decision • What Is Bariatric Surgery? • Understand the Risks and Benefits • Recovering from Surgery • Set Realistic Goals and Expectations • Find Out If You Qualify • Check Your Insurance Coverage Official Recommendations Informational Websites Ask Your Surgeon Questions References Note: Click on any of the content contained in the Table of Contents to link directly to that section.
For the Physician Put Your Patient’s Mind at Ease £ Most insurance plans require additional documentation that confirms: £ Reduce your patient’s stress. Help them understand they have had a long battle and this is a difficult decision • other methods of weight loss have been unsuccessful requiring lifelong commitment. • performance of daily activities is seriously impaired £ Dispel myths and discuss the benefits of this surgery as • psychological evaluation demonstrating that the outlined below. patient is able to adhere to post-surgical behavior £ Provide patient education information. management requirements • patient demonstrates compliance with a 3- to 6-month Review the Risks of Morbid Obesity presurgical weight reduction program £ Obesity multiplies the risk of developing medical • patient is free of any substance abuse problems, conditions by 2- to 5-fold. 1, 3 including smoking £ An estimated 300,000 deaths per year are caused by £ Female candidates who are in their childbearing years — obesity-related conditions. 2 about 80 percent of morbidly obese adults in the Many patients with morbid obesity are not fully aware of U.S. — should be willing to wait at least one year after their comorbidities or of the relationship between these surgery before becoming pregnant. 14 conditions and their weight. 4 Emphasize the Importance of Behavioral Reinforce the Health Benefits and Psychological Readiness of Weight Loss £ Bariatric surgery is an adjunct, not an alternative, to Bariatric surgery has been shown to be a highly effective lifestyle changes. means of achieving lasting weight loss in the majority of • Entails a lifetime commitment to following dietary patients, resulting in significant reduction or resolution of: 5–13 restrictions, adhering to an exercise program, • type 2 diabetes • arthritis/joint pain taking dietary supplements and complying with follow-up recommendations • insulin resistance • depression • There may be complications that require • metabolic syndrome • obstructive sleep subsequent procedures • hypertension apnea • There may be unpleasant side effects over a period • dyslipidemia • sexual dysfunction of several years • Gastroesophageal Reflux £ Determine whether your patient: • menstrual irregularity Disease (GERD) • Is well-informed and highly motivated • Polycystic Ovary • asthma Syndrome (PCOS) • Has a supportive family or social environment The most dramatic outcomes are seen in those who lose • Does not smoke or drink alcohol the most weight and maintain the loss. 5 • Does not have untreated severe depression or other mental disease Discuss Your Patient’s Candidacy for Bariatric Surgery Explain Bariatric Surgery £ Bariatric surgery as a treatment for morbid obesity is an There are insurance requirements for surgery, which are accepted option for severely obese patients who do not outlined below. The bariatric program will work with your respond to nonsurgical treatment. patient to help meet these requirements; however, it is 1, 2 Bariatric surgery is comprised mainly of 4 types of procedures: important for the patient to understand these requirements ahead of time. • restrictive (gastric banding, sleeve gastrectomy) £ Clinical criteria: • malabsorptive (gastric bypass) • 18 years or older • combination (biliopancreatic diversion or BPD) • BMI of 40 or greater £ Discuss the option of minimally invasive (laparoscopic) surgery. • BMI of 35 or greater plus at least 1, 14 one serious comorbidity • Most bariatric procedures are now performed laparoscopically, with comparable efficacy to open £ Bariatric surgery may also be considered as a treatment procedures option for those with mild to moderate obesity and type 23 (Thomson-Reuters, 2010) 2 diabetes. 14, 15 • Advantages include fewer wound complications, less postoperative pain, a shorter hospital stay and quicker postoperative recovery 14
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Shared Decision Making Patient Physician A Mutually Acceptable ...

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