Thursday, June 30, 2011

Resist One Day Surgery for Some Bariatric Procedures

According to a recent article in the Houston Chronicle, while Houston has a rising population, "there's a drop in the number of people using [Houston area] hospital beds and the length of time they spend in them." Among the reasons for the decline in hospital bed usage and length of stay are the tightened restrictions insurance companies have imposed on patient admittance and length of stay. Also among the reasons for the decline is improvement in technology used to treat patients. This improvement is evident, worldwide, in bariatric surgery. Indeed, advances in technology have helped to lower the length of stay associated with a number of bariatric surgical procedures.

Laparoscopic techniques are among the technologies that have contributed to this length of stay shortening. Today, some lap band procedures are done on an outpatient basis, with a patient’s hospital stay being one day.

Now, there is a push by some consultants to make gastric bypass surgery a one day event. However, experts insist that gastric bypass surgery requires a length of stay of at least two days.

Dr. John Morton, "director of bariatric surgery and staff at hospitals and clinics at Stanford University in California," insists that too early discharges would have serious consequences.

Reviewing 51,788 gassing bypass outcomes, Dr. Morton concluded "that patients who left the hospital on the day of the surgery were 12 times more likely to have serious complications than those who stayed for two days." And the 30 day mortality rate was higher for the patients who were released on the day of the bariatric surgery.

Of course, a decrease in hospital length of stay is a money saver in many cases. However, if reducing the length of stay causes complications, the shortened period would likely increase rather than decrease the cost of the surgery. So, the best practice, now, is probably to adhere to a minimum two day length of stay for gastric bypass surgery until the risk of serious complications is lowered.

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Friday, June 17, 2011

An Automatic Food Diary

Nonsurgical weight loss and weight management are difficult but possible. A national group called the National Weight Control Registry shows that it is possible to lose weight and maintain a goodly amount of the weight loss. And keeping a food diary is an important tool used by persons in the registry. However, food diaries are often inaccurate. But a physician suggests that a minor modification to food-diary use can increase a diary's accuracy.

The physician is Tim Harlan. And he writes in the Huffington Post that planning your meals is a key to improving the accuracy of the food diary. He calls the planning a way to create an automatic diary. That is, by planning next week's meals and snacks, a person can compute, in advance, the number of calories the person will ingest during the week. So, assuming the person sticks to an established plan, that person automatically has an accurate account of the calories in the coming week's diet.

Having an accurate accounting of the calories you take in is important in weight loss and weight control. Like everything else, if you don't measure it, you can't manage it. Indeed, to some extent, Harlan's advice reflects the sentiment of other weight loss experts. Some experts insist that in order to control your diet, you should adhere to a similar diet each day. Further, you should prepare your own meals and avoid eating out. These actions will give you an excellent opportunity to know your food calorie content, before you eat the food, enabling you to better count the calories.

Perhaps, weight loss providers should emphasize, even more, the importance of meal planning in weight loss and weight control. The providers could encourage an individual to spend some time during the weekend planning the next week's meals. And the providers could advise an individual to eat sparingly when away from home, since it may be difficult to determine the calorie content of food eaten in places other than the home. These actions could enable a person to more accurately account for the calories in their future diet. Thus, the person could obtain a more accurate food diary, and, perhaps, more weight control.

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Wednesday, June 1, 2011

PCP Practice Guidelines for Obesity Treatment

Since a primary care physician (PCP) is the medical provider that most overweight or obese patients come in contact with, a set of tested weight loss clinical guidelines could improve the PCP's weight loss treatment. And the guidelines could include steps for bringing in other experts, when appropriate. These other experts might include bariatric physicians and bariatric surgeons.

Investigators at the University of Maryland established a project to create a program that could be used by PCPs to identify, evaluate, and treat obese adults. Sixty PCPs were surveyed to determine a set of clinical practice guidelines (CPGs).

A program was then developed based on the CPGs. The program was later given to 26 providers to use. After following the program, more than 70% of the providers indicated that the guidelines would improve obesity treatment. The providers also indicated that because of their use of the guidelines, the providers would be more likely to refer obese patients to a bariatric surgeon. We believe, however, that before a PCP refers a patient to a bariatric surgeon, the PCP should consult a bariatric physician. Further, we believe that the PCP guidelines should include steps for including bariatric physicians in the obesity treatment.

Since bariatric physicians are trained to treat overweight and obese individuals, these physicians can provide weight loss and weight management services that a PCP may not be equipped to provide, unless the PCP has been trained in bariatric medicine.

The American Society of Bariatric Physicians (ASBP) has established a set of practice guidelines for bariatric physicians. The guidelines include an "Initial Patient Work-up," consideration of "Medications and Other Therapeutic Modalities," and the establishment of a maintenance program.

So while obesity-treatment guidelines for PCPs are warranted, the inclusion of bariatric physicians in the overall weight loss and weight management process is worth considering in the guidelines. Overweight and obesity are enormous problems. And there are roles to play for the PCP, the bariatric physician, and the bariatric surgeon.

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