Guest guest Posted February 5, 2003 Report Share Posted February 5, 2003 WE see all pts presurgery for about an hour for diet instruction (we are not involved in an assessment process unless the insurance company requests one). One month following surgery, we have another class that focuses on diet as well as other issues once the pt is back on their feet and eating solid food. The practice we are with has support groups and they have recently requested another " class " to meet the needs of pts 3 months out. This is minimal, and I would suggest at least 3 hrs per pt - 1 hr pre surgery, and 1-2 hrs post over 6-12 month period. Note of interest, about a year ago we went to classes to teach the diets to better meet the demands of the surgeons. As outpatient RD's for a hospital, we found so many of our time slots were filled with gastric bypass pts that we couldn't see as many other pts. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 So, is the presurgery hour a class too? How many patients are in one session? Does that seem to work? If you were able to make any changes you wanted with your process to improve the care, what would you do? Kendra McConahy, R.D. > Re: Bariatric RD's > > WE see all pts presurgery for about an hour for diet instruction (we are > not involved in an assessment process unless the insurance company > requests one). One month following surgery, we have another class that > focuses on diet as well as other issues once the pt is back on their feet > and eating solid food. > The practice we are with has support groups and they have recently > requested another " class " to meet the needs of pts 3 months out. > This is minimal, and I would suggest at least 3 hrs per pt - 1 hr pre > surgery, and 1-2 hrs post over 6-12 month period. > Note of interest, about a year ago we went to classes to teach the diets > to better meet the demands of the surgeons. As outpatient RD's for a > hospital, we found so many of our time slots were filled with gastric > bypass pts that we couldn't see as many other pts. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 --- You wrote: Plus, is dumping a problem with gastric band patients or not??? --- end of quote --- Dumping is not a problem with gastric band patients as food still follows the same pathway from their stomach to their intestines. Unfortuneately sweets are well tolerated and easily digested, so if pts are having problems eating they frequently turn to eating sweets. Therefore sweeteaters are not good candidates for banding procedures. Banding procedures are better for patients that eat large quantities at meal times and do not do a lot of snacking between meals. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 This is so helpful! Since I am just getting started with seeing these patients, could you please share a general outline of what topics you discuss at each session??? Specifically, what are the nutrition parameters/concerns for post-op?? Any info would be appreciated. Plus, is dumping a problem with gastric band patients or not??? Thanks! Re: Bariatric RD's > WE see all pts presurgery for about an hour for diet instruction (we are not involved in an assessment process unless the insurance company requests one). One month following surgery, we have another class that focuses on diet as well as other issues once the pt is back on their feet and eating solid food. > The practice we are with has support groups and they have recently requested another " class " to meet the needs of pts 3 months out. > This is minimal, and I would suggest at least 3 hrs per pt - 1 hr pre surgery, and 1-2 hrs post over 6-12 month period. > Note of interest, about a year ago we went to classes to teach the diets to better meet the demands of the surgeons. As outpatient RD's for a hospital, we found so many of our time slots were filled with gastric bypass pts that we couldn't see as many other pts. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 Please share. I am also just getting started developing a program for a MD. I was wondering if any of you do this privately or just through a hospital. I have tons of questions. Amy Re: Bariatric RD's This is so helpful! Since I am just getting started with seeing these patients, could you please share a general outline of what topics you discuss at each session??? Specifically, what are the nutrition parameters/concerns for post-op?? Any info would be appreciated. Plus, is dumping a problem with gastric band patients or not??? Thanks! Re: Bariatric RD's > WE see all pts presurgery for about an hour for diet instruction (we are not involved in an assessment process unless the insurance company requests one). One month following surgery, we have another class that focuses on diet as well as other issues once the pt is back on their feet and eating solid food. > The practice we are with has support groups and they have recently requested another " class " to meet the needs of pts 3 months out. > This is minimal, and I would suggest at least 3 hrs per pt - 1 hr pre surgery, and 1-2 hrs post over 6-12 month period. > Note of interest, about a year ago we went to classes to teach the diets to better meet the demands of the surgeons. As outpatient RD's for a hospital, we found so many of our time slots were filled with gastric bypass pts that we couldn't see as many other pts. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 I agree, I have gastric band patients who eat sweets instead of meats and vegetables because they tolerate them better!!!! Re: Bariatric RD's --- You wrote: Plus, is dumping a problem with gastric band patients or not??? --- end of quote --- Dumping is not a problem with gastric band patients as food still follows the same pathway from their stomach to their intestines. Unfortuneately sweets are well tolerated and easily digested, so if pts are having problems eating they frequently turn to eating sweets. Therefore sweeteaters are not good candidates for banding procedures. Banding procedures are better for patients that eat large quantities at meal times and do not do a lot of snacking between meals. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2003 Report Share Posted February 6, 2003 Thank you! This is what I assumed. Thanks for confirming it for me. Re: Bariatric RD's > --- You wrote: > Plus, is > dumping a problem with gastric band patients or not??? > --- end of quote --- > > Dumping is not a problem with gastric band patients as food still follows the same pathway from their stomach to their intestines. Unfortuneately sweets are well tolerated and easily digested, so if pts are having problems eating they frequently turn to eating sweets. Therefore sweeteaters are not good candidates for banding procedures. Banding procedures are better for patients that eat large quantities at meal times and do not do a lot of snacking between meals. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2003 Report Share Posted February 9, 2003 -- We talk to the patient just prior to surgery for 15-20 minutes, then in the hospital for 15-20 minutes, and 3 scheduled outpatient visits for 15-20 minutes each and 2 follow-up phone calls about 5 minutes each. Also, the patient has our phone number for any other concerns/questions. Penny > First of all I wanted to thank everyone that responded to my original request > regarding bariatric nutrition. > > Secondly, if anyone works with these patients can you give me an estimate of > how much time you spend (on average) with a patient? I know this is difficult > to determine...I am just looking for an average time length though. We are > looking at hiring a bariatric surgeon and they want me to propose how much time > I would need to see patients. > > Thank you for the help. > > Alvardo, RD > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2003 Report Share Posted February 9, 2003 The presurgery class is an hour (sometimes longer if there are a lot of questions) It seems to be working out real well. We try to limit the class to 6-8 pts - though at the beginning we had up to 14 which is ok but we feel a smaller group is better THe interaction is nice and they offer each other some helpful tips as well as support. If I could improve it, I would like more follow up. I do not teach the post surgery class so often do not always know what things are problematic. The patients do have our phone number and we take calls but that is only if they have questions or problems. I think ideally, it would be the best to have 6 month and 1 year f/u with labs as I wonder how many people fall off the track with their supplements and food choices - afterall, the surgery is only a tool and if the pt does not take the time or understand the importance of making the proper food choices, then they will end up malnourished and unhealthy. I like to stress that we do not only want to loose the wt but we also want to be healthy enough to enjoy our lives - which means eating right and exercising (no way around that one, right?!!) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2003 Report Share Posted February 10, 2003 I see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after. We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing? I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2003 Report Share Posted February 10, 2003 Hi Beth and others, Could you please elaborate a little on your expectations for wt loss. If you have any references, I'd love to read those too. We've asked our surgeons several times what they consider "losing wt too fast" but they don't respond very concisely. Thanks for any help in this area!! Tammie O.>>> mew9d@... 02/10/03 11:41AM >>> We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2003 Report Share Posted February 10, 2003 We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2003 Report Share Posted February 11, 2003 , Thank you so much for your help. Which labs exactly? Are they the same at every visit? Kendra > Re: Bariatric RD's > > I see patients one on one for every appt. I see them for one hour at > their initial appt. where we review previous attempts at dieting, previous > hx of disordered eating, as well as the gastric bypass diet. I then see > them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them > on a yearly basis after that. Labs are ordered starting at 4 months and > then at every appt after. > > We have discussed the idea of group education but I was not sure it would > work. All of my appts are scheduled in conjunction with either the > surgeon or the nurse practitioner. I find if they are scheduled just to > see me I have a higher incidence of no shows. For those of you that do > group meetings, how does that scheduling work? Do you find many people > not showing? > > I do find that at 1-2 years post-op is when people either stop taking > their vitamins or start to fall back into old habits (i.e., frequently > snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard > multiple times that people stop taking their vitamins b/c they feel as > though they are eating better than they ever have so they don't need them. > I, too, stress the need for good eating habits so they do not trade one > health problem for another. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2003 Report Share Posted February 12, 2003 How much a patient loses really depends on how much they have to lose. Pts with more to lose will lose more faster than those in the lower BMI ranges. I usually look at % excess body weight loss to determine how they are doing. Most pts lose ~15-20% of excess body weight at 1 month, 30-50% excess body weight at 4 months. By a year, they should be ~60-70%. We do notice that pt that have DM tend to lose a little slower than those that don't. I, too, focus a lot on making sure they are eating well and exercising and not so much on weight loss. If they are following the guidelines, the weight loss will come. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2003 Report Share Posted February 12, 2003 My surgeon stated that >50# by 3 months and >110# by 6 months is too much weight. However, the amount of weight loss the first 6 months depends on how much you weight prior to surgery. The higher weight before surgery the more weight loss a patient will have the first year. A lot of my patients compare themselves to other friends, family, or other people who have had this surgery. I encourage them not to focus on the success of other people because every human body responds differently. I encourage good nutrition and change in eating behaviors. I have seen pt's who lose more than the weights above in those time frames. If this occurs, I make sure they are eating enough meals and protein throughout the day. I may even ask for an albumin or prealbimun just to check however, I think I have only checked this once on a patient who had to be reoperated on for a SBO. I do not have a set number for my expectation for weight loss because I encourage pt's not to be focused on the number on the scale. My main objective is to guide their way the first year and counsel about good dietary behaviors and exercise for a healthy life. When they come in for their follow up visit I always do a diet history/recall, ask how many meals+snacks/d, portion sizes, grams of protein, oz of low-cal fluids/d, and do they exercise and how often? If a patient is not satisfied with their rate of weight loss (which most patient expect faster weight loss than possible) then I give suggestions for changes in their diet that may be beneficial. During the pt's initial work-up we ask the patients what their goal weight would be to see if they are being realistic or not. Studies have found that after 1 year the average weight loss is ~66% of the excess weight above their ideal body weight. From my experience, the pt's who exercise and change eating behaviors lose more than 66% and keep it off where pt's who are non-compliant with diet change start gaining their weight back after 2 years. Also, the younger pt's tend to loss more weight than older pt's. I am assuming the reason for this is higher metabolism and ability to exercise more. I have many studies which I received from the previous RD that worked in this clinic. I do not have them on my computer or on hand right now but I can get back with you in the future with the references. I hope this answered your question. Beth -----Original Message-----From: tammy.kilps@... [mailto:tammy.kilps@...]Sent: Monday, February 10, 2003 12:40 PM Subject: RE: Bariatric RD's Hi Beth and others, Could you please elaborate a little on your expectations for wt loss. If you have any references, I'd love to read those too. We've asked our surgeons several times what they consider "losing wt too fast" but they don't respond very concisely. Thanks for any help in this area!! Tammie O.>>> mew9d@... 02/10/03 11:41AM >>> We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2003 Report Share Posted February 12, 2003 Fabulous info - thanks! Keep looking for those resources - I'd bet most of us could benefit from a reference list. Lots of info seems to exist about the surgical procedures but not too much that would be ideal for patient teaching. Thanks again!! Tammie O >>> mew9d@... 02/12/03 04:02PM >>> My surgeon stated that >50# by 3 months and >110# by 6 months is too much weight. However, the amount of weight loss the first 6 months depends on how much you weight prior to surgery. The higher weight before surgery the more weight loss a patient will have the first year. A lot of my patients compare themselves to other friends, family, or other people who have had this surgery. I encourage them not to focus on the success of other people because every human body responds differently. I encourage good nutrition and change in eating behaviors. I have seen pt's who lose more than the weights above in those time frames. If this occurs, I make sure they are eating enough meals and protein throughout the day. I may even ask for an albumin or prealbimun just to check however, I think I have only checked this once on a patient who had to be reoperated on for a SBO. I do not have a set number for my expectation for weight loss because I encourage pt's not to be focused on the number on the scale. My main objective is to guide their way the first year and counsel about good dietary behaviors and exercise for a healthy life. When they come in for their follow up visit I always do a diet history/recall, ask how many meals+snacks/d, portion sizes, grams of protein, oz of low-cal fluids/d, and do they exercise and how often? If a patient is not satisfied with their rate of weight loss (which most patient expect faster weight loss than possible) then I give suggestions for changes in their diet that may be beneficial. During the pt's initial work-up we ask the patients what their goal weight would be to see if they are being realistic or not. Studies have found that after 1 year the average weight loss is ~66% of the excess weight above their ideal body weight. From my experience, the pt's who exercise and change eating behaviors lose more than 66% and keep it off where pt's who are non-compliant with diet change start gaining their weight back after 2 years. Also, the younger pt's tend to loss more weight than older pt's. I am assuming the reason for this is higher metabolism and ability to exercise more. I have many studies which I received from the previous RD that worked in this clinic. I do not have them on my computer or on hand right now but I can get back with you in the future with the references. I hope this answered your question. Beth -----Original Message-----From: tammy.kilps@... [mailto:tammy.kilps@...]Sent: Monday, February 10, 2003 12:40 PM Subject: RE: Bariatric RD's Hi Beth and others, Could you please elaborate a little on your expectations for wt loss. If you have any references, I'd love to read those too. We've asked our surgeons several times what they consider "losing wt too fast" but they don't respond very concisely. Thanks for any help in this area!! Tammie O.>>> mew9d@... 02/10/03 11:41AM >>> We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2003 Report Share Posted February 13, 2003 I have a question for those of you working with LapBand pts. Does your physician or practice have a criteria for when pts get fills? How does the pt know when they need a fill? Beverly Millison MS RD/LD CDE Clinical Coordinator, MNT Medical Center of ville 972-219-5113 - office 972-420-1891 - fax Beverly.Millison@... RE: Bariatric RD's How much a patient loses really depends on how much they have to lose. Pts with more to lose will lose more faster than those in the lower BMI ranges. I usually look at % excess body weight loss to determine how they are doing. Most pts lose ~15-20% of excess body weight at 1 month, 30-50% excess body weight at 4 months. By a year, they should be ~60-70%. We do notice that pt that have DM tend to lose a little slower than those that don't. I, too, focus a lot on making sure they are eating well and exercising and not so much on weight loss. If they are following the guidelines, the weight loss will come. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2003 Report Share Posted February 13, 2003 I am working on my Master's in Nutrition Education (almost finished)and have been counceling gastric bypass patients for the past 6 months. Many of my academic projects focus on this population and I have collected many research papers on gastic bypass surgery. I believe that I have the reference that you are referring to: Factors influencing energy intake and body weight loss after gastric bypass. Bobbioni-Harsch E, et al. European Journal of Clinical Nutrition (2002)56, 551-556. They found that subjects under the age of 35, with an initial body weight greater than 120 kg lost the most weight. The younger patients ate less and therefore lost more weight. They reference another study that found that obese, older women have blunted lipolytic activity. They suggest that older women have a decreased capability to supply energy through the mobilization of lipids from fat stores and hence, need to get more calories from food intake. This may explain the difference in weight loss, Kay. > Fabulous info - thanks! Keep looking for those resources - I'd bet most of us could benefit from a reference list. Lots of info seems to exist about the surgical procedures but not too much that would be ideal for patient teaching. Thanks again!! Tammie O > > >>> mew9d@h... 02/12/03 04:02PM >>> > > My surgeon stated that >50# by 3 months and >110# by 6 months is too much weight. However, the amount of weight loss the first 6 months depends on how much you weight prior to surgery. The higher weight before surgery the more weight loss a patient will have the first year. A lot of my patients compare themselves to other friends, family, or other people who have had this surgery. I encourage them not to focus on the success of other people because every human body responds differently. I encourage good nutrition and change in eating behaviors. I have seen pt's who lose more than the weights above in those time frames. If this occurs, I make sure they are eating enough meals and protein throughout the day. I may even ask for an albumin or prealbimun just to check however, I think I have only checked this once on a patient who had to be reoperated on for a SBO. I do not have a set number for my expectation for weight loss because I encourage pt's not to be focused on the number on the scale. My main objective is to guide their way the first year and counsel about good dietary behaviors and exercise for a healthy life. When they come in for their follow up visit I always do a diet history/recall, ask how many meals+snacks/d, portion sizes, grams of protein, oz of low-cal fluids/d, and do they exercise and how often? If a patient is not satisfied with their rate of weight loss (which most patient expect faster weight loss than possible) then I give suggestions for changes in their diet that may be beneficial. During the pt's initial work-up we ask the patients what their goal weight would be to see if they are being realistic or not. Studies have found that after 1 year the average weight loss is ~66% of the excess weight above their ideal body weight. From my experience, the pt's who exercise and change eating behaviors lose more than 66% and keep it off where pt's who are non-compliant with diet change start gaining their weight back after 2 years. Also, the younger pt's tend to loss more weight than older pt's. I am assuming the reason for this is higher metabolism and ability to exercise more. I have many studies which I received from the previous RD that worked in this clinic. I do not have them on my computer or on hand right now but I can get back with you in the future with the references. I hope this answered your question. > > Beth > Re: Bariatric RD's > > > I see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after. > > We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing? > > I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2003 Report Share Posted February 13, 2003 Terrific - thanks!!!>>> kervc@... 02/13/03 01:50PM >>> I am working on my Master's in Nutrition Education (almostfinished)and have been counceling gastric bypass patients for the past6 months. Many of my academic projects focus on this population and Ihave collected many research papers on gastic bypass surgery. Ibelieve that I have the reference that you are referring to: Factorsinfluencing energy intake and body weight loss after gastric bypass. Bobbioni-Harsch E, et al. European Journal of Clinical Nutrition(2002)56, 551-556.They found that subjects under the age of 35, with an initial bodyweight greater than 120 kg lost the most weight. The younger patientsate less and therefore lost more weight. They reference anotherstudy that found that obese, older women have blunted lipolyticactivity. They suggest that older women have a decreased capabilityto supply energy through the mobilization of lipids from fat storesand hence, need to get more calories from food intake. This mayexplain the difference in weight loss, Kay.> Fabulous info - thanks! Keep looking for those resources - I'd betmost of us could benefit from a reference list. Lots of info seems toexist about the surgical procedures but not too much that would beideal for patient teaching. Thanks again!! Tammie O > > >>> mew9d@h... 02/12/03 04:02PM >>>> > My surgeon stated that >50# by 3 months and >110# by 6 months is toomuch weight. However, the amount of weight loss the first 6 monthsdepends on how much you weight prior to surgery. The higher weightbefore surgery the more weight loss a patient will have the firstyear. A lot of my patients compare themselves to other friends,family, or other people who have had this surgery. I encourage themnot to focus on the success of other people because every human bodyresponds differently. I encourage good nutrition and change in eatingbehaviors. I have seen pt's who lose more than the weights above inthose time frames. If this occurs, I make sure they are eating enoughmeals and protein throughout the day. I may even ask for an albumin orprealbimun just to check however, I think I have only checked thisonce on a patient who had to be reoperated on for a SBO. I do nothave a set number for my expectation for weight loss because Iencourage pt's not to be focused on the number on the scale. My mainobjective is to guide their way the first year and counsel about gooddietary behaviors and exercise for a healthy life. When they come infor their follow up visit I always do a diet history/recall, ask howmany meals+snacks/d, portion sizes, grams of protein, oz of low-calfluids/d, and do they exercise and how often? If a patient is notsatisfied with their rate of weight loss (which most patient expectfaster weight loss than possible) then I give suggestions for changesin their diet that may be beneficial. During the pt's initialwork-up we ask the patients what their goal weight would be to see ifthey are being realistic or not. Studies have found that after 1 yearthe average weight loss is ~66% of the excess weight above their idealbody weight. From my experience, the pt's who exercise and changeeating behaviors lose more than 66% and keep it off where pt's who arenon-compliant with diet change start gaining their weight back after 2years. Also, the younger pt's tend to loss more weight than olderpt's. I am assuming the reason for this is higher metabolism andability to exercise more. I have many studies which I received fromthe previous RD that worked in this clinic. I do not have them on mycomputer or on hand right now but I can get back with you in thefuture with the references. I hope this answered your question. > > Beth> Re: Bariatric RD's> > > I see patients one on one for every appt. I see them for one hourat their initial appt. where we review previous attempts at dieting,previous hx of disordered eating, as well as the gastric bypass diet.I then see them at 1 month, 4 months, and 1 year post-op for 30minutes. We see them on a yearly basis after that. Labs are orderedstarting at 4 months and then at every appt after.> > We have discussed the idea of group education but I was not sure itwould work. All of my appts are scheduled in conjunction with eitherthe surgeon or the nurse practitioner. I find if they are scheduledjust to see me I have a higher incidence of no shows. For those ofyou that do group meetings, how does that scheduling work? Do youfind many people not showing?> > I do find that at 1-2 years post-op is when people either stoptaking their vitamins or start to fall back into old habits (i.e.,frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). Ihave heard multiple times that people stop taking their vitamins b/cthey feel as though they are eating better than they ever have so theydon't need them. I, too, stress the need for good eating habits sothey do not trade one health problem for another.> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2003 Report Share Posted February 15, 2003 In response to question re how well attended are the group sessions- We hold ~6 classes per month with a limit of 10 per group and we have very few no shows. Every once in a while a person may cancel but they end up reschduling for another session. Note that it is required that they come to the group for diet instruction before their surgery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 Very interesting information. I recently (9/02) started a post-op nutrition class for patients to continue for long term follow-up regarding not-only nutrition, but also behavioral changes and physical activity. Most of patients are one year out or less. However, I recently had 2 patients contact me about joining the program that are 2 years out and their weight loss has stalled or they have noticed a slight gain (5#), which seems to fluctuate. I told them that I first wanted them to start keeping detailed records so that I have some information to resource. One of the patients says she has 35# more to lose to get to her goal weight. I am not positive what this goal weight is based upon, but I am concerned that maybe she has reached her 'set goal weight'...if this is possible. The gastric bypass surgery has only been performed at my facilty for a little over a year, so no one has any experience regarding patients needs/concerns past one year. Expected maximum weight loss was one question I had - but I believed that has been answered. A few other questions I have about patients post-op are: 1. Exepcted volume tolerated at one 'meal' - 1 year out and 2+ years out are out and expected volume for one day approx. 2+ years out? ( I have read approx. 3 cups food total for a day at 2+ years) 2. Alcohol and liver damage for patients post-op gastric bypass. Some of my patients are tolerating alcoholic beverages and are concerned why this is an 'absolute' restriction (listed as such at my facility)...is it just for the carb content or is there another underlying reason? a , MS, RD, LD Carle Weight Management Center Champaign, IL 61821 RE: Bariatric RD's My surgeon stated that >50# by 3 months and >110# by 6 months is too much weight. However, the amount of weight loss the first 6 months depends on how much you weight prior to surgery. The higher weight before surgery the more weight loss a patient will have the first year. A lot of my patients compare themselves to other friends, family, or other people who have had this surgery. I encourage them not to focus on the success of other people because every human body responds differently. I encourage good nutrition and change in eating behaviors. I have seen pt's who lose more than the weights above in those time frames. If this occurs, I make sure they are eating enough meals and protein throughout the day. I may even ask for an albumin or prealbimun just to check however, I think I have only checked this once on a patient who had to be reoperated on for a SBO. I do not have a set number for my expectation for weight loss because I encourage pt's not to be focused on the number on the scale. My main objective is to guide their way the first year and counsel about good dietary behaviors and exercise for a healthy life. When they come in for their follow up visit I always do a diet history/recall, ask how many meals+snacks/d, portion sizes, grams of protein, oz of low-cal fluids/d, and do they exercise and how often? If a patient is not satisfied with their rate of weight loss (which most patient expect faster weight loss than possible) then I give suggestions for changes in their diet that may be beneficial. During the pt's initial work-up we ask the patients what their goal weight would be to see if they are being realistic or not. Studies have found that after 1 year the average weight loss is ~66% of the excess weight above their ideal body weight. From my experience, the pt's who exercise and change eating behaviors lose more than 66% and keep it off where pt's who are non-compliant with diet change start gaining their weight back after 2 years. Also, the younger pt's tend to loss more weight than older pt's. I am assuming the reason for this is higher metabolism and ability to exercise more. I have many studies which I received from the previous RD that worked in this clinic. I do not have them on my computer or on hand right now but I can get back with you in the future with the references. I hope this answered your question. Beth -----Original Message-----From: tammy.kilps@... [mailto:tammy.kilps@...]Sent: Monday, February 10, 2003 12:40 PM Subject: RE: Bariatric RD's Hi Beth and others, Could you please elaborate a little on your expectations for wt loss. If you have any references, I'd love to read those too. We've asked our surgeons several times what they consider "losing wt too fast" but they don't respond very concisely. Thanks for any help in this area!! Tammie O.>>> mew9d@... 02/10/03 11:41AM >>> We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 We say "NO" here because of the empty calories. -----Original Message-----From: kristina [mailto:eatright-bfit@...]Sent: Friday, February 21, 2003 8:44 PM Subject: Re: Bariatric RD's Very interesting information. I recently (9/02) started a post-op nutrition class for patients to continue for long term follow-up regarding not-only nutrition, but also behavioral changes and physical activity. Most of patients are one year out or less. However, I recently had 2 patients contact me about joining the program that are 2 years out and their weight loss has stalled or they have noticed a slight gain (5#), which seems to fluctuate. I told them that I first wanted them to start keeping detailed records so that I have some information to resource. One of the patients says she has 35# more to lose to get to her goal weight. I am not positive what this goal weight is based upon, but I am concerned that maybe she has reached her 'set goal weight'...if this is possible. The gastric bypass surgery has only been performed at my facilty for a little over a year, so no one has any experience regarding patients needs/concerns past one year. Expected maximum weight loss was one question I had - but I believed that has been answered. A few other questions I have about patients post-op are: 1. Exepcted volume tolerated at one 'meal' - 1 year out and 2+ years out are out and expected volume for one day approx. 2+ years out? ( I have read approx. 3 cups food total for a day at 2+ years) 2. Alcohol and liver damage for patients post-op gastric bypass. Some of my patients are tolerating alcoholic beverages and are concerned why this is an 'absolute' restriction (listed as such at my facility)...is it just for the carb content or is there another underlying reason? a , MS, RD, LD Carle Weight Management Center Champaign, IL 61821 RE: Bariatric RD's My surgeon stated that >50# by 3 months and >110# by 6 months is too much weight. However, the amount of weight loss the first 6 months depends on how much you weight prior to surgery. The higher weight before surgery the more weight loss a patient will have the first year. A lot of my patients compare themselves to other friends, family, or other people who have had this surgery. I encourage them not to focus on the success of other people because every human body responds differently. I encourage good nutrition and change in eating behaviors. I have seen pt's who lose more than the weights above in those time frames. If this occurs, I make sure they are eating enough meals and protein throughout the day. I may even ask for an albumin or prealbimun just to check however, I think I have only checked this once on a patient who had to be reoperated on for a SBO. I do not have a set number for my expectation for weight loss because I encourage pt's not to be focused on the number on the scale. My main objective is to guide their way the first year and counsel about good dietary behaviors and exercise for a healthy life. When they come in for their follow up visit I always do a diet history/recall, ask how many meals+snacks/d, portion sizes, grams of protein, oz of low-cal fluids/d, and do they exercise and how often? If a patient is not satisfied with their rate of weight loss (which most patient expect faster weight loss than possible) then I give suggestions for changes in their diet that may be beneficial. During the pt's initial work-up we ask the patients what their goal weight would be to see if they are being realistic or not. Studies have found that after 1 year the average weight loss is ~66% of the excess weight above their ideal body weight. From my experience, the pt's who exercise and change eating behaviors lose more than 66% and keep it off where pt's who are non-compliant with diet change start gaining their weight back after 2 years. Also, the younger pt's tend to loss more weight than older pt's. I am assuming the reason for this is higher metabolism and ability to exercise more. I have many studies which I received from the previous RD that worked in this clinic. I do not have them on my computer or on hand right now but I can get back with you in the future with the references. I hope this answered your question. Beth -----Original Message-----From: tammy.kilps@... [mailto:tammy.kilps@...]Sent: Monday, February 10, 2003 12:40 PM Subject: RE: Bariatric RD's Hi Beth and others, Could you please elaborate a little on your expectations for wt loss. If you have any references, I'd love to read those too. We've asked our surgeons several times what they consider "losing wt too fast" but they don't respond very concisely. Thanks for any help in this area!! Tammie O.>>> mew9d@... 02/10/03 11:41AM >>> We recently started group meetings for all initial Gastric Bypass pt's back in August. It usually last for 2 1/2 hours in the morning prior to their schedule appointment. All pt's are required to attend the session prior to surgery. Pt's first meet with the nurse coordinator which explains the medical issues, complications, what to expect during their hospital stay, and she shows a slide show of previous pt's. Then, I will meet with them for an hour to review the diet and expected wt loss patterns. Lastly, they meet with a secretary to go over insurance issues. We began this orientation session b/c it was impossible for me to see ~10-15 initials/d and spend up to 1 hour with each of them + ~20 work-ups/follow-ups in the same day. I usually have ~30-45 pt's on my list every Thursday. The group session has been a great success. The advantages I have seen with the group session is that pt's ask questions which other pt's may not have ever thought of asking, we also use a board which we can draw examples to help the pt's understand the information better. Many pt's have told us that they really enjoy the orientation and found it very informative. On the other hand, I do not recommend video taping your lecture and playing it for pt's. I have had some pt's come from other hospitals which sat them in front of a TV and had them watch the information. First, they can't ask any questions. Secondly, some pt's told me they could not understand the medical terminology the doctor's and RD's were using. Beyond the group orientation I also see the pt's one-on-one for their nutrition evaluation for insurance. I try to see every pt during every appointment and in the hospital before they go home. Our pt's come in for their initial visit, work-up, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly. Beth -----Original Message-----From: .D.Letendre@... [mailto:.D.Letendre@...]Sent: Monday, February 10, 2003 8:49 AM Subject: Re: Bariatric RD'sI see patients one on one for every appt. I see them for one hour at their initial appt. where we review previous attempts at dieting, previous hx of disordered eating, as well as the gastric bypass diet. I then see them at 1 month, 4 months, and 1 year post-op for 30 minutes. We see them on a yearly basis after that. Labs are ordered starting at 4 months and then at every appt after.We have discussed the idea of group education but I was not sure it would work. All of my appts are scheduled in conjunction with either the surgeon or the nurse practitioner. I find if they are scheduled just to see me I have a higher incidence of no shows. For those of you that do group meetings, how does that scheduling work? Do you find many people not showing?I do find that at 1-2 years post-op is when people either stop taking their vitamins or start to fall back into old habits (i.e., frequently snacking on Cheez-its, pretzels, popcorn, or PB crx). I have heard multiple times that people stop taking their vitamins b/c they feel as though they are eating better than they ever have so they don't need them. I, too, stress the need for good eating habits so they do not trade one health problem for another. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 I think there is a need for criteria and recommendations for >3 months post surgery - It is an area where more research would be helpful!! RE alcohol, from my experience a lot of people like to hear that it is ok but in reality we are doing them no favors - First off it is a gastric irritant so drinking in the first few weeks is not going to help the healing process. Second, the alcohol is going to be absorbed much more quickly so they really need to be careful. Thirdly, alcohol has a high caloric content and no nutrtion - How is that going to help them lose weight-much less be healthy? I think it is our ressponsibility to tow the hard line - Chances are they are going to drink anyway but my feeling is that they may be less likly to drink a lot if they were told it was not a good idea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Another interesting fact which I read on alcohol and bariatric surgery is the effect of 1 drink post-op is equivalent to 3 drinks prior to surgery. I usually do not recommend alcohol until 6 months post-op and I educate them on calorie content. With my experience, I had a pt who was drinking 7 shots/d and she was very disappointed she was not losing substantial weight. She did not realize how many calories she was drinking/d. I am not sure if she cut back but she was shocked about the amount of empty calories. -----Original Message-----From: Nutrizz6RD@... [mailto:Nutrizz6RD@...]Sent: Saturday, February 22, 2003 5:37 PM Subject: Re: Bariatric RD'sI think there is a need for criteria and recommendations for >3 months post surgery - It is an area where more research would be helpful!! RE alcohol, from my experience a lot of people like to hear that it is ok but in reality we are doing them no favors - First off it is a gastric irritant so drinking in the first few weeks is not going to help the healing process. Second, the alcohol is going to be absorbed much more quickly so they really need to be careful. Thirdly, alcohol has a high caloric content and no nutrtion - How is that going to help them lose weight-much less be healthy? I think it is our ressponsibility to tow the hard line - Chances are they are going to drink anyway but my feeling is that they may be less likly to drink a lot if they were told it was not a good idea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2003 Report Share Posted February 26, 2003 --- You wrote: Now this is interesting.....! I just got a phone call from a woman that I evaluated pre-op in the fall. Apparently Aetna has a new policy in this service area: they will not approve bariatric surgery until the individual has been under the supervision of an RD for a diet for a period of 6 months. --- end of quote --- The same is true for Cigna. It needs to be a medically supervised diet, with weekly (I think) monitoring. What I'm sure of is whether or not Cigna would pay for a pt to see their PCP/RD every week for 6 months. Quote Link to comment Share on other sites More sharing options...
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