RE: POSSIBLE conflict of interest issue

[Guest guest]

surgeons want to cut and make $$, not to say that there aren't wonderful ones- I know some who are-but they want the patients to be approved by us (RD's) so that they can get their $$- this is where the 'conflict of interest may be interpreted. I don't think that any one else should do the MNT for this group- we are the appropriate professionals to do this service.

Point is that the more referrals you get from the surgeon, the more $$ they make and the more $$ the RD makes. Is this a conflict of interest or just the process?

As medical professionals MD's and RD's are supposed to adhere to standards of practice as well as state/local laws, and bylaws of the governing institution (if applicable) with regard to healthcare.

Surgeons who are in the arena of bariatric surgery are making a lot of $$ for sure.

Clinical Chemistry -- Hølleland et al. 45 (2) 189 I think ~ $70, not sure http://www.clinchem.org/cgi/content/full/45/2/189 <<Clinical Chemistry -- Hølleland et al. 45 (2) 189.url>>

[Guest guest]

I want to add to this because I just had a conversation with one of the

RD's who thinks RD's should be " anti " bariatric surgery because she feels

that we should be promoting weight management with better lifestyle

choices.

We provide MNT for cardiac patients who had bypass and patients with T2DM,

even though big factor in both conditions is poor nutrition and exercise

habits. I think we need to be careful not to be judgmental about how

others choose to live their lives, but to offer the best nutrition advise

for the situation they are in.

Naomi Wedel, M.S., R.D., C.D.E., C.D.

naomi.wedel@...

Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

Phone: (608) 824-4207

Fax: (608) 824-4349

[Guest guest]

I think that's a great point, and I find the other RD's comment ironic,

because I work exclusively with bariatric patients, and all I do every

day tis promote weight loss/maint with better lifestyle choices!

>>> naomi.wedel@... 12/18/03 12:14PM >>>

I want to add to this because I just had a conversation with one of

the

RD's who thinks RD's should be " anti " bariatric surgery because she

feels

that we should be promoting weight management with better lifestyle

choices.

We provide MNT for cardiac patients who had bypass and patients with

T2DM,

even though big factor in both conditions is poor nutrition and

exercise

habits. I think we need to be careful not to be judgmental about how

others choose to live their lives, but to offer the best nutrition

advise

for the situation they are in.

Naomi Wedel, M.S., R.D., C.D.E., C.D.

naomi.wedel@...

Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

Phone: (608) 824-4207

Fax: (608) 824-4349

[Guest guest]

Also, if we're not involved, who's going to do it? We have a responsibility

to the public to contribute and make sure that whatever decision is made by

the patient's primary caregiver (the doctor, NOT the RD), that it is carried

out in the safest way possible for the sake of the patient. If we 'wash our

hands' of this, it will not be done well and patients will suffer more.

Kendra W. McConahy, R.D.

Clinical Nutrition Manager

Largo Medical Center

> Re: POSSIBLE conflict of

> interest issue

>

> I think that's a great point, and I find the other RD's comment ironic,

> because I work exclusively with bariatric patients, and all I do every

> day tis promote weight loss/maint with better lifestyle choices!

>

>

>

> >>> naomi.wedel@... 12/18/03 12:14PM >>>

>

> I want to add to this because I just had a conversation with one of

> the

> RD's who thinks RD's should be " anti " bariatric surgery because she

> feels

> that we should be promoting weight management with better lifestyle

> choices.

>

> We provide MNT for cardiac patients who had bypass and patients with

> T2DM,

> even though big factor in both conditions is poor nutrition and

> exercise

> habits. I think we need to be careful not to be judgmental about how

> others choose to live their lives, but to offer the best nutrition

> advise

> for the situation they are in.

>

> Naomi Wedel, M.S., R.D., C.D.E., C.D.

> naomi.wedel@...

> Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

> Phone: (608) 824-4207

> Fax: (608) 824-4349

>

>

>

>

>

[Guest guest]

AMEN!!!!

Re: POSSIBLE conflict of

interest issue

I think that's a great point, and I find the other RD's comment ironic,

because I work exclusively with bariatric patients, and all I do every

day tis promote weight loss/maint with better lifestyle choices!

>>> naomi.wedel@... 12/18/03 12:14PM >>>

I want to add to this because I just had a conversation with one of

the

RD's who thinks RD's should be " anti " bariatric surgery because she

feels

that we should be promoting weight management with better lifestyle

choices.

We provide MNT for cardiac patients who had bypass and patients with

T2DM,

even though big factor in both conditions is poor nutrition and

exercise

habits. I think we need to be careful not to be judgmental about how

others choose to live their lives, but to offer the best nutrition

advise

for the situation they are in.

Naomi Wedel, M.S., R.D., C.D.E., C.D.

naomi.wedel@...

Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

Phone: (608) 824-4207

Fax: (608) 824-4349

[Guest guest]

The RD you are referring to is ignorant to the purpose of gastric bypass surgery. It is only a tool to help people adopt healthier dietary and lifestyle habits. It is up to us and the other multidisciplinary staff to educate our patients/clients to the best of our abilities.

Just my two cents! Thanks for the comment!

Kate Alie, M.S., R.D., L.D.

Re: POSSIBLE conflict of interest issue

I want to add to this because I just had a conversation with one of theRD's who thinks RD's should be "anti" bariatric surgery because she feelsthat we should be promoting weight management with better lifestylechoices.We provide MNT for cardiac patients who had bypass and patients with T2DM,even though big factor in both conditions is poor nutrition and exercisehabits. I think we need to be careful not to be judgmental about howothers choose to live their lives, but to offer the best nutrition advisefor the situation they are in.Naomi Wedel, M.S., R.D., C.D.E., C.D.naomi.wedel@...Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717Phone: (608) 824-4207Fax: (608) 824-4349

[Guest guest]

I totally agree. I admit I was very skeptical and very resistant to becoming

involved, especially since one of our endocrine/diabetes patients died after

the surgery.

But, since the surgeon I work with is so diligent and wants the best for his

patients if I wasn't going to do it-who would? Not that there are not other

RDs well qualified, but in our health care systems they would likely assign

it to an already over-loaded inpatient RD who may really not have the time

and then it is really the patients who suffer. So, at least I figure I am

there to support those who have made the choice to pursue this route.

One " problem " I have however is the fact that some centers (and patients)

seem to be making it more of a cosmetic type surgery and even having people

gain more weight to qualify. I have been more than verbal about refusing to

work with this type of practice.

, RD

> Re: POSSIBLE conflict of

> > interest issue

> >

> > I think that's a great point, and I find the other RD's comment ironic,

> > because I work exclusively with bariatric patients, and all I do every

> > day tis promote weight loss/maint with better lifestyle choices!

> >

> >

> >

> > >>> naomi.wedel@... 12/18/03 12:14PM >>>

> >

> > I want to add to this because I just had a conversation with one of

> > the

> > RD's who thinks RD's should be " anti " bariatric surgery because she

> > feels

> > that we should be promoting weight management with better lifestyle

> > choices.

> >

> > We provide MNT for cardiac patients who had bypass and patients with

> > T2DM,

> > even though big factor in both conditions is poor nutrition and

> > exercise

> > habits. I think we need to be careful not to be judgmental about how

> > others choose to live their lives, but to offer the best nutrition

> > advise

> > for the situation they are in.

> >

> > Naomi Wedel, M.S., R.D., C.D.E., C.D.

> > naomi.wedel@...

> > Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

> > Phone: (608) 824-4207

> > Fax: (608) 824-4349

> >

> >

> >

> >

> >

[Guest guest]

, RD wrote:

" One " problem " I have however is the fact that some centers (and patients)

seem to be making it more of a cosmetic type surgery and even having people

gain more weight to qualify. I have been more than verbal about refusing to

work with this type of practice. "

Sadly, it is true. Some spouses and friends of patients have told me that

they feel like gaining some weight to qualify for the surgery. Assumption

of the lay people about the surgery is unreal! Almost everyone I've met

for pre-op eval believes that they will lose weight effortlessly after the

surgery! Most think that " their small stomach " is going to fix everything

including addiction to food, emotional eating, poor eating habits,

listening to their hunger and fullness cues, etc. That's one of the reason

I ask about what they know about the diet after the surgery, and how they

think it's going to help them lose weight. They need serious nutrition

education.

Naomi Wedel, M.S., R.D., C.D.E., C.D.

naomi.wedel@...

Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

Phone: (608) 824-4207

Fax: (608) 824-4349

[Guest guest]

Great point Naomi. I hear these same things every day. At times it is very difficult to convince someone who has not yet had surgery of their very important role in creating a successful outcome. Which of course can be frustrating. I find that most people overestimate just how much the surgery will help them and and are unaware of it's limitations. I also find that asking a patient to describe their understanding of how the surgery will aid in weight loss, as well as their own role, provides very important assessment information.

Marcus, R.D., C.D.N.

Center for Weight Management North Shore-Long Island Jewish Health System 410 Lakeville Road, Suite 212 New Hyde Park, New York 11042 Tel (718/516) 470-4012 Fax (516) 616-9061

-----Original Message-----From: naomi.wedel@... [mailto:naomi.wedel@...]Sent: Thursday, December 18, 2003 5:26 PM Subject: RE: POSSIBLE conflict of interest issue , RD wrote:"One "problem" I have however is the fact that some centers (and patients)seem to be making it more of a cosmetic type surgery and even having peoplegain more weight to qualify. I have been more than verbal about refusing towork with this type of practice."Sadly, it is true. Some spouses and friends of patients have told me thatthey feel like gaining some weight to qualify for the surgery. Assumptionof the lay people about the surgery is unreal! Almost everyone I've metfor pre-op eval believes that they will lose weight effortlessly after thesurgery! Most think that "their small stomach" is going to fix everythingincluding addiction to food, emotional eating, poor eating habits,listening to their hunger and fullness cues, etc. That's one of the reasonI ask about what they know about the diet after the surgery, and how theythink it's going to help them lose weight. They need serious nutritioneducation.Naomi Wedel, M.S., R.D., C.D.E., C.D.naomi.wedel@...Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717Phone: (608) 824-4207Fax: (608) 824-4349

[Guest guest]

I am an RD and a gastric-bypass patient.

I can attest to the fact that this does promote a lifestyle change. I agree it is a drastic move and big decision -- but for some of us it is very much needed and can be very successful.

I do not think RD's in general should be "anti" bariatric surgery as one of you on this list pointed out -- I think you should be realistic about the issues obese individuals have to deal with and the decisions they need to make.

RD LD

laurel MD (6-months post op and 90 pounds lighter)

K.

[Guest guest]

I like your approach, !

Strathdee, RD, LD, LMHC, CEDS

>From: " Marcus, " <emarcus@...>

>Reply-

> " ' ' "

>< >

>Subject: RE: POSSIBLE conflict of interest

>issue

>Date: Thu, 18 Dec 2003 18:27:14 -0500

>

>Great point Naomi. I hear these same things every day. At times it is very

>difficult to convince someone who has not yet had surgery of their very

>important role in creating a successful outcome. Which of course can be

>frustrating. I find that most people overestimate just how much the surgery

>will help them and and are unaware of it's limitations. I also find that

>asking a patient to describe their understanding of how the surgery will

>aid

>in weight loss, as well as their own role, provides very important

>assessment information.

>

>

> Marcus, R.D., C.D.N.

>

>Center for Weight Management

>North Shore-Long Island Jewish Health System

>410 Lakeville Road, Suite 212

>New Hyde Park, New York 11042

>Tel (718/516) 470-4012

>Fax (516) 616-9061

>

> RE: POSSIBLE conflict of interest

>issue

>

>

>

> , RD wrote:

>

> " One " problem " I have however is the fact that some centers (and patients)

>seem to be making it more of a cosmetic type surgery and even having people

>gain more weight to qualify. I have been more than verbal about refusing to

>work with this type of practice. "

>

>Sadly, it is true. Some spouses and friends of patients have told me that

>they feel like gaining some weight to qualify for the surgery. Assumption

>of the lay people about the surgery is unreal! Almost everyone I've met

>for pre-op eval believes that they will lose weight effortlessly after the

>surgery! Most think that " their small stomach " is going to fix everything

>including addiction to food, emotional eating, poor eating habits,

>listening to their hunger and fullness cues, etc. That's one of the reason

>I ask about what they know about the diet after the surgery, and how they

>think it's going to help them lose weight. They need serious nutrition

>education.

>

>Naomi Wedel, M.S., R.D., C.D.E., C.D.

>naomi.wedel@...

>Dean West Clinic, 752 N. High Point Rd., Madison, WI 53717

>Phone: (608) 824-4207

>Fax: (608) 824-4349

>

>

>

>

>