Guest guest Posted February 26, 2003 Report Share Posted February 26, 2003 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. -----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 March 6, 2003 Report Share Posted March 6, 2003 Same thing here - I ended up starting a small weight loss group for several employees (all had the same Aetna policy that prior to surgery they need 6 months of an RD supervised wt loss program). Only one or two are seriously considering the surgery but I applaud the policy as it gives RD's opportunites to help people find the best solutions for their weight loss problems. Quote Link to comment Share on other sites More sharing options...
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