Duodenal switch weight loss surgery involves the surgeon removing a portion of the small intestine, thereby reducing the nutrient and calorie absorption of food. It is most helpful in those patients with veryhigh BMIs or severe or multiple obesity-related health conditions. Roux-en-Y gastric bypass surgery involves removing a portion of the stomach, making it about the size of an egg. The body then cannot absorb as many nutrients and calories and the patient feels fuller, leading to weight loss. Vertical sleeve gastrectomy surgery also involves removing a large portion of the stomach, but no artificial openings need to be created to the small intestine, thus easing digestionand subsequent side effects. The patient is still able to feel fuller after eating and absorb fewer calories. Sometimes a combination of these procedures is used, such as a shortening of the intestine and removing a portion of the stomach (Banner Health, 2019).
EFFECTS OF OBESITY7The standard of practice at Banner Health involves comprehensive care. The weight loss clinic team incorporates several different specialties to develop the plan of care. The bariatric surgeon meets with the patient to help decide on the best approach to weight loss (Banner Health,2019). A psychologist will conduct a psychological evaluation to determine readiness for bariatric surgery and will also provide support to help the patient understand and deal with a changing self-image and emotions after the surgery. A registered dietician is available to help with lifestyle changes for the non-surgical candidates and help post-surgical patients with new dietary needs. An exercise specialist will help patients plan and implement a strategy for physical activity to aid in weight loss. A registered nurse will help provide clinical support and answer questions. The weight loss centers provide continued support after surgery in the form ofsupport groups, and nutrition and exercise support (Banner Health, 2019).Pharmacological TreatmentsSeveral evidence-based pharmacological treatments are available in the state of Arizona for obesity treatment. Orlistat (Xenical or Alli) is a medication that promotes weight loss by inhibiting fat absorption in the gastrointestinal tract (Kumar & Aronne, 2017). An average dose of 120 mg three times a day reduces fat absorption by about 30%. Studies have shown that compared to placebo, patients lost significantly more weight during the first year of treatment and regained less weight during the second year of treatment. Patients also saw an added benefit of lower insulin levels and better glycemic control. Major side effects include decreased vitaminabsorption and oily stools (Kumar & Aronne, 2017). A controlled-release, combination pill containing phentermine and topiramate (Qysmia) is approved for long-term treatment of obesity in patients with a BMI greater than 30 and with a weight-related comorbidity (Kumar & Aronne, 2017). Phentermine is thought to promote weight
EFFECTS OF OBESITY8loss by increasing norepinephrine, which leads to decreased food intake.
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