Introduction to Utah Surgical Associates

The surgeons at Utah Surgical Associates are committed to the care of patients who are struggling with
their weight. Since January of 2004, we have provided surgical care and follow-up for patients undergoing
weight loss surgery. We have successfully partnered with St. George Regional Hospital (SGRH) to provide an
integrated multidisciplinary team approach to patient care.

Laparoscopic gastric bypass has been performed since the onset of this program.
As different surgical approaches have been developed, we have incorporated those
procedures that we feel have shown significant success in the treatment of this illness.
With this in mind, sleeve gastrectomy has been added to our program.

With a team approach and careful post-operative care our patients have been able to achieve remarkable
success. We hope this manual will help you to understand the issues involved in this important and life changing
event. We are committed to helping you achieve your goals.

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 Introduction to Obesity Surgery
Basic definitions used for obesity surgery
Surgery for weight loss is becoming a common method for treatment of severe obesity and its associated
illnesses. This document is to educate the patient considering surgical weight loss about different types of
surgery available, the risks of the procedure, the benefits of surgical weight loss and the requirements for a
successful outcome.
Certain words are commonly used in discussing these surgical procedures. For better understanding the
following definitions are provided:
· B MI (body mass index)- a measure of an adults weight in relation to their height. Used to compare the
obesity of patients with different heights. If a patient’s height were 6’3” and they weighed 200lbs then that
would be a normal weight, but if the same patient were 5’0’’ then they would be severely obese (BMI of 25
compared to 39 respectively). T h e B M I is calculated as weight in kilograms divided b y height in meters
squared (kg/m2). This is number can be obtained using BMI calculators that are available on the internet or
using the tables we have provided.
· Obesity- defined as having a high amount of body fat in comparison to lean body mass. Specifically, a BMI
of 30 or greater.
· Bariatrics- the branch of medicine dealing all aspects of obesity.
· Comorbidities- diseases caused by specific underlying conditions. In this particular case, the illnesses and
problems caused by obesity.

The obesity epidemic

Surgical weight loss has been around in various forms for more than thirty years. Recently, a lot of attention
has been focused on these procedures because of an explosion in obesity rates around the country and indeed
around the world. In certain states in this country more than 25% of the population are obese having BMI’s
greater than 30. Three in five Americans are either overweight or obese. In the past 20 years, adult obesity has
doubled. It is estimated that more than 300,000 premature deaths occur annually because of obesity. The death
rate from obesity is rapidly approaching that of smoking.

Causes of the obesity epidemic

Genetic predisposition: Obesity tends to run in families. Studies of children from “overweight” parents
adopted into “thin” families show that the children’s weight mirrors their biologic parents. The search is on for
the “obesity gene”.
Physiologic: Complex hormonal interactions exist that are not completely understood, but are an important
area of active research and possible future therapy. These interactions have developed over many generations of
human history and have been important for human survival throughout our history. Unfortunately, food is
plentiful today and these factors are contributing to the explosion of obesity.
Behavioral: Food is intimately intertwined into our behaviors and family traditions. Many of the
pleasurable moments in our lives are associated with eating. Food addictions are common. Food is a comfort and
pleasure that is difficult to replace.
Gender: Women have a higher incidence of obesity.
Socioeconomic: High fat/calorie food is inexpensive and readily available. It costs more to eat healthy.
Exercise can also be an expensive hobby.
Psychosocial: Food can be a mechanism for coping with stress and abuse.
Societal: Modern society is filled with labor saving devices. Exercise and activity have become optional.
Technology has contributed greatly to our high quality of living, but also has been a major contributor to our high
obesity rates. 2
Energy Imbalance
The basic cause of obesity is an energy imbalance. If you think about it, less than 100 years ago people lived
very different lives. Most people worked hard to make a living and episodes of famine were common. The
human race has lived for many thousands of years in this fashion. Those people who could absorb and store
energy efficiently survived the famines and were able to pass along their genes.
We now live in a completely different society, but our genes haven’t changed. We are basically living in a
modern society with Stone Age genes. There is a huge supply of food that is low in cost, always available,
attractive, tasty, and hygienic. In addition, labor-saving technologies have virtually eliminated the need for
physical activity in everyday life. Activity is now optional. This is a very simple equation:
Increased Caloric Intake+ Decreased Energy Expenditure= Energy Storage/Fat Deposition
We are literally eating so much and storing so much fat that our bodies and organs are unable to handle the
consequences. This problem is not just a cosmetic issue. The weight is not just unsightly, its dangerous. The
body is impacted on almost every level and the most important organ systems in our body are compromised. We
call these consequences of obesity comorbidities. Below is a list of the most common illnesses associated with
obesity.

Obesity related illness (Comorbidities)

Obesity increases the incidence of these specific diseases:

Diabetes GERD/Heartburn

Hypertension (high blood pressure) Depression

High triglycerides/cholesterol Liver failure/Cirrhosis

Heart disease/Stroke Gallstones

Obstructive Sleep Apnea Infertility

Pulmonary Hypertension Urinary incontinence

Heart Failure Blood clots/DVT’s

Degenerative Joint Disease Gout

Cancer (endometrial, breast,prostate, colorectal) and others....

Psychological Impact of Obesity

In addition to the adverse impact obesity has on the body, there is an impact on the mind and psyche. People
with obesity are frequently depressed and feelings of social isolation are common. Social phobias are also very
common. Even without the phobias patients find it difficult to cope with the consequences of their size. Fitting
through turnstiles, sitting in theaters, finding a seat on an airplane, finding stylish clothes, etc., can be challenging
and embarrassing.
Society has not come to terms with this epidemic and the obese are frequently the target of discrimination.
Discrimination in the workplace is rampant. Comedians and movies frequently use overweight people as the
butt of their jokes. Obesity is the last bastion of discrimination.

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 Criteria for Weight Loss Surgery
National Institutes of Health Consensus Statement
In 1991, the National Institutes of Health convened an panel of experts to evaluate the available treatments for
obesity. All the research on the medical and surgical options for weight loss were evaluated. The panel then
generated a statement explaining their findings.
The panel found no evidence to support the effectiveness of medical weight loss. Specifically, it stated that
the available diets, exercise, and medications were ineffective at long term weight loss for the “morbidly obese”.
They found the weight loss with dieting to be small and the weight was regained in almost every patient.
The panel also found clear evidence of the effectiveness of surgical weight loss in the treatment of these same
patients. A majority of the excess weight was lost with surgery and the weight loss was maintained when
following patients out 10 years.
The consensus panel also made recommendations regarding who would benefit from surgery. These
guidelines are followed by most weight loss programs. These criteria are based on a patients BMI and the
illnesses they have developed as a consequence of their excess weight.

Criteria for Weight Loss Surgery

The NIH Consensus Panel recommends that a patient is a candidate for surgery if:
1. Patients have a Body Mass Index > 40 kg/m 2 .
2. Patients have a Body Mass Index between 35 and 40 kg/m 2 with obesity related illnesses.
http://consensus.nih.gov/1991/1991GISurgeryObesity084html.htm

Body Mass Index Table

Normal Overweight Obese Extreme Obesity

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

Height
(inches) Body Weight (pounds)

58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258

59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267

60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276

61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285

62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295

63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304

64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314

65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324

66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334

67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344

68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354

69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365

70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376

71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386

72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397

73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408

74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420

75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431

76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443
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 Weight Loss Surgery Options

Roux-en-Y Gastric Bypass these risks are relatively low. We want all patients
considering surgical weight loss to understand the risks
prior to surgery. Below is a list of some common risks
associated with gastric bypass surgery.
Bleeding, infection, spleen or liver injury, blood
clots (DVT’s), pulmonary embolus (blood clots
traveling to the heart/lungs), pneumonia, heart
attack/arrhythmia, anastamotic leak (leak at the bowel
connections), conversion from a laparoscopic approach
(small incisions) to an open approach, and death
(approximately 1/200 or 0.5%)
Late Complications: Hernias (more common with
open surgery), ulcers, intestinal obstruction, outlet
stenosis (narrowing of the connection between stomach
and bowel), anemia/nutritional deficiencies (all
patients are required to take vitamin/mineral
supplements), osteoporosis (all patients should take
calcium citrate supplements, and dumping (usually
only occurs when wrong food choices are made,
therefore is helpful for weight loss).

Advantages/Disadvantages of Gastric Bypass

Roux en Y Gastric Advantages:
Bypass · Rapid intial weight loss
· Minimally invasive approach is possible
The gastric bypass is considered by many the
gold standard obesity operation. We compare other · Longer experience in USA with longer follow-up
weight loss surgery outcomes to this surgery to · Minimal diet restrictions
compare effectiveness. It has been studied for many · <1% need for repeat surgery
years and long term outcomes are well known.
Disadvantages:
A small pouch, approximately 1 ounce in size, is
created at the top of the stomach. · Cutting, stapling and rerouting of the bowel is
required
The small bowel is divided. The biliopancreatic
limb is reattached to the small bowel. · More operative complications than sleeve

The other end is connected to the pouch, creating · Duodenum (first part of small intestine) is
the Roux limb. bypassed (this is where much of the iron and
calcium is absorbed)
The small pouch releases food slowly, causing a
sensation of fullness with very little food. · Technically less complex if preformed laparoscopically

The biliopancreatic limb preserves the action of · Difficult to reverse

the digestive tract by allowing bile and pancreatic
fluids to mix with the food from the pouch. These
substances are necessary for normal absorption of
nutrients.

Risks of gastric bypass

All surgical procedures are associated with risk.
With appropriate patient selection and preparation

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 Weight Loss Surgery Options
Sleeve Gastrectomy
Sleeve gastrectomy is a relatively new procedure. Advantages/Disadvantages of Sleeve Gastrectomy
It has been used for many years in conjunction with a
malabsorptive procedure such as a duodenal switch/
biliopancreatic diversion. It is currently being used as Advantages:
a stand alone procedure that combines some of the · No intestinal rerouting
benefits of the gastric bypass and the gastric band
procedures. · No bypass of the duodenum (where much of
the calcium and iron is absorbed)
· N o dump ing sy ndro me
The procedure is performed laparoscopically. It
· Less risk of ulcer
usually entails an
overnight stay in the · Little risk of internal hernias and bowel
hospital. obstructions
A tube is placed
down the esophagus
Disadvantages:
into the stomach and
used to guide a · Staple line complications
stapler that cuts and · No dumping syndrome (this can help motivate
seals the stomach. patients to avoid “sweets”)
All the stomach,
except that which is · Slightly less weight loss compared to a
around the tube, is Gastric Bypass
removed creating a · Increased acid reflux in some patients and
narrow tube of the tendency to develop hiatal hernia
stomach.
The procedure
effectively restricts
calorie intake. It has
the advantages of letting food enter the digestive tract
normally like a gastric band, but the problems
associated with the foreign body/band are solved.

Risks of sleeve gastrectomy

All surgical procedures are associated with risk.
With appropriate patient selection and preparation
these risks are relatively low. We want all patients
considering surgical weight loss to understand the
risks prior to surgery. Below is a list of some common
risks associated with a sleeve gastrectomy.
Bleeding, infection, spleen injury, liver injury,
blood clots, pulmonary embolus (clots that travel to
the lungs), heart attack/arrhythmia, bowel injury,
conversion to open surgery from laparoscopy, staple
line leak, stomach obstruction, weight regain (can
happen with all weight loss operations), and death
(0.02%).

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 What are my Next Steps for Weight Loss?
Step towards surgery Date
Date completed seminar:
1) Determine if you meet the criteria for surgery (See p. 4 for criteria)
*Must be over 18. Ages 70-75 are evaluated on case by case basis and may need
additional clearances. Patients weighing greater than 450lbs/70+ BMI will need to
be referred to another program.
2) Watch weight loss seminar https://utahsurgical.com/procedures/bariatric-weight-
loss-surgery/
3) After watching weight loss seminar video, email lhiner@utahsurgical.com or
jenny.thompson@imail.org to get credit for first criteria. Please include name,
DOB, contact info, BMI, obesity related illnesses, referring physician and
insurance. We will then send you a detailed overview of our program.

1) Call your insurance for bariatric specific requirements. If you have two
insurances, please contact both. Insurance companies may need a procedure
code- Laparoscopic sleeve gastrectomy 43775/Laparoscopic Roux-en-Y gastric
bypass 43644
2) If you have insurance questions, please call Lorraine Hiner (435) 625-0220 to
coordinate insurance information and to verify benefits.
3) Start medically supervised diet with physician of choice (PCP or dietician). Month 1:
Record dates of each visit. Insurance requires that you not skip a month or you Month 2:
will be asked to start over. Your first visit initiates the diet, therefore, the date of Month 3:
your second visit counts as the completion of 1 month. For example: If your Month 4:
insurance requires you to complete a 3-month diet. Typically, you will need 4 visits Month 5:
over at least a 90-day period. (* If you are self-pay you do not need to do this Month 6:
step. ) Month 7:
4) Set up nutrition and psych evaluation (See p.13 for phone #’s for providers) Dietician name & appointment
Ask providers to fax notes to Lorraine Hiner at (877) 588-3498 if not an date:
intermountain healthcare physician.
*Note steps 4 and 5 can be done at the same time Psych provider and
appointment date:

5) Call Lorraine Hiner (435) 625-0220 approximately 1 month prior to completing Surgeon:
your requirements to set up your surgical consult. Ask your physician to fax Date of Consult:
supervised diet and exercise clinical notes to Attn: Lorraine Hiner (877) 588-3498 if
physician is not an intermountain healthcare provider.

6) Contact Jenny Thompson (435) 251-1632/jenny.thompson@imail.org Date of pre-op class:

7) to register for a pre-op class after you have received your surgeon consult
appointment.
*Virtual Pre-op Classes are 2/4th Tuesdays of each month 10-12.

8) Go to surgeon consult and schedule surgery during your visit. Additional Provider Name:
clearances may be requested by your surgeon dependent on medical history.
Medical clearances will need to be received before going ahead with surgery. Date of surgery:

9) Complete pre-operative labs and tests required a week prior to surgery date.
Labs will be ordered at your surgeons consult and electronically sent to an
intermountain facility. When you arrive at the facility the lab will be in the computer
system waiting for you.

10) Join our virtual support group. It is highly suggested. Studies show individuals
who attend support group have better outcomes. Please contact Jenny Thompson
at 435-251-1632/jenny.thompson@imail.org to register.

DRMC New Beginnings virtual support group class via Web Ex is scheduled 3rd
Wednesday of every month 5:30-6:30 PM.

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 Date to start pre-op diet:
11) 2 weeks prior to surgery date start your liquid protein diet.

Jenny Thompson MSN RN Lorraine Hiner

Bariatric Coordinator Bariatric Coordinator
Specialty Care Coordinator II-Bariatrics Utah Surgical Associates
Associates 1490 E Foremaster Dr. Ste 200
Intermountain Healthcare | St. George Regional Hospital St. George, UT 84790
Dr. #200
Ph. 435-625-0220/Fax
1380 E Medical Center Drive (2nd floor Program Specialist Office)
84790 lhiner@utahsurgical.com
St. George, Utah 84790
877-588-3498
Office: 435.251.1632 | jenny.thompson@imail.org

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 Frequently Asked Questions
1. Why do I need a dietary consult?

This is to teach you the skills to choose the right food and nutrients to nourish your body and help with overall
success in sustainable weight loss that is permanent. https://intermountainhealthcare.org/services/wellness-
preventive-medicine/live-well-centers/st-george-live-well/?utm_campaign=gmb-
website&utm_medium=organic&utm_source=google

2. How recent does my supervised diet need to be as I have tried many diets over the years?

In general, most insurance companies require supervised diets to be within the last year. Please contact your
insurance company to get your specific guidelines.

3. What happens if I am at a 35 BMI, but I go under during my supervised diet?

This depends on your insurance company some will look at your previous weights over the last year and use it as
a baseline. Other insurances require that you stay above 35 BMI no matter what. Contact your insurance for
specifics.

4. What if I fall just under BMI or I don’t have obesity related illness?

Intermountain offers several programs by the Live Well Center such as the weight to health program, nutrition
consults, and various wellness and fitness classes. https://intermountainhealthcare.org/services/wellness-
preventive-medicine/live-well-centers/st-george-live-well/ or call (435) 251-3793.

5. I see the age requirement cut off is 70 but I am 73. What can I do?

If you are between 70-75 the doctors will evaluate you on a case by case basis. Please have medical records sent
to Utah Surgical Associates for review. Fax (435)628-1660 or email to lhiner@utahsurgical.com. The doctor
will review your records and access your risk level. Then the office will contact you with the decision.
Additional clearances may be requested.

6. Why do I need to have a psychiatric evaluation?

The intent is to make sure there is no untreated psychological illnesses that might compromise the outcome of
your surgery. Weight loss surgery is a stressful event that can cause worsening of underlying psychiatric
diseases. Having a resource available that you feel comfortable with prior to surgery can be valuable in
managing psychological symptoms post-operatively and help with behavioral modification needed to be
successful life-long.

7. If I am already seeing a psychiatrist can I use them for the psych evaluation?

Yes, you can use your own psychiatrist. Please contact Utah Surgical Associates for specific topics that needs to
be addressed and documented in this visit.

8. Are the suggested providers the only ones that I can see?

No, you can choose your own provider. These are just recommendations.

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 Frequently Asked Questions
9. How quickly can I get in to have surgery?

Self-pay patients typically can be seen within a couple months as they do not have to complete a medically
supervised diet. Patients that are following insurance guidelines have to complete the medically supervised diet,
nutrition consult and psychiatric assessment. Insurance patients can take anywhere from 3-6 months on average
depending on how long the insurance company dictates for the supervised diet. We recommend you schedule
your dietician consult and psych evaluation concurrently while you are completing your medically supervised
diet. Then upon completion you will be ready to schedule your consult and pre-op class.

10. What if my insurance company doesn’t have bariatric benefits is their funding available?

You can look into funding through a bank or contact Prosper Healthcare Lending (prosperhealthcare.com or 866-
602-6066). I also recommend rechecking your specific insurance benefits at the beginning of each calendar year
to see if benefits have changed. It may be that bariatric benefits aren’t available this calendar year but the
following year it has been added as a benefit.

11. Is payment expected in full to the doctor, hospital and anesthesia before I have surgery?

Self pay patients must pay the entire amount prior to their surgery to each individual department. Payment is
expected at least 7 day prior to surgery to avoid possible cancellation of your surgery. In general, for patient’s
that are using insurance, the surgeon’s office and the hospital will request a $500.00 to $1000.00 pre-surgery
payment if your yearly deductible has not been met. For payment at SGRH, please contact Katie Hansen (801)
442-9647 or Larry (801) 357-0806. For payment at Utah Surgical Associates, please contact Lorraine Hiner at
(435) 767-9405 or Audry (435) 767-9423. For payment at Mountain West Anesthesia, please contact Keeley at
(801) 432-2624.

12. Why are you more expensive than other surgeons out of the country?

Our price includes a comprehensive program with providers available 24/7. This includes resources such as ER,
anesthesia, imaging, IV infusion clinics, ICU etc. Therefore, if complications were to arise we are able to offer
many service lines to evaluate your problem. Our program is an accredited center which means our program
meets the highest standards in safety, quality and reliability. These standards come with regulations that dictate
best practice from how to disinfect instrumentation properly, to best surgical technique, to pre and post-operative
protocols which allow for better outcomes. Our prices also include the manpower and hours to make sure that
you have the safest, best quality outcome. Self-pay prices are all inclusive which means they include the surgeon
consult, post op appts and life-time bariatric follow-ups.

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 Frequently Asked Questions
13. Why should I choose your program over medical tourism where the fees are cheaper?

All surgeries come with risk; however, it is proven that accredited centers have lower risks associated with them
than non-accredited center. This is because being accredited means the program follows national standards for
bariatric surgery. MBSAQIP (Metabolic Bariatric Surgeons Accreditation Quality Improvement Program) is a
governing body that follows ASMBS (American Society for Metabolic and Bariatric Surgeons) guidelines. These
are specific standards that are researched and proven to be best practice. This allows for the advancement of safe
and high-quality care. These guidelines dictate that certain physical and human resources be available at all times
to allow for the best outcome possible. I would advise if you are seeking treatment outside of the US that you
thoroughly research the facility. Complication risk reporting may be skewed and misleading from these facilities as
they don’t always include post-operative complications that are treated in the US. If complications were to arise
from your surgery once you are back in the US your insurance can deny all charges associated with the procedure
making all payments out of pocket for you. Recently, Utah has seen an increase in an antibiotic resistant bug
known as pseudomonas aeruginosa associated with medical tourism and bariatric surgeries. Please refer to the Utah
Health Department link and the CDC for facts on this life-threatening illness.
https://www.cdc.gov/hai/outbreaks/pseudomonas-aeruginosa.html

https://health.utah.gov/featured-news/utah-resident-dies-following-surgical-procedure-in-tijuana-mexico

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 BARIATRIC SURGERY
Pre-Operative Liquid Diet

Purpose: The Pre-Operative Liquid Diet is a method used to reduce the amount of fat around the liver. This
makes the liver more pliable, allowing the surgeon easier access to the stomach. The diet is to be started 2
weeks prior to surgery. This liquid diet is high in protein, minimal in carbohydrate, and 900-1200 calories.

Guidelines:

1. The main component of the diet is a liquid protein supplement (see list).

2. Caloric intake ranges 900-1200, depending on which and how many supplements are consumed.

3. More than one brand and/or flavor of supplement can be consumed to increase variety.

4. Hydration can be accomplished with water and sugar free/calorie free beverages such as Crystal Light
(including store brands and Mio drops), sugar free gelatin, low sodium broth, sugar free Popsicles,
coffee, tea, and diet carbonated beverages, such as Diet Coke (no sugar or fat added).

5. The multi-vitamin/mineral supplement can be started during the pre-operative liquid diet.

Please direct questions regarding diet to the Outpatient Dietitian: 435-251-3789

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 Golden Rules of Successful Weight Loss
Golden Rules
If you are seriously considering weight loss surgery, you need to carefully examine this list of rules. These
rules, if followed, will allow you to meet your goals of weight loss and better health. All of the operations,
described previously, are tools. To be effective a tool has to be used appropriately. A list of instructions typically
accompanies a tool that is purchased. These acquaint the new owner with the appropriate use of the equipment
to achieve the desired goal. Without these instructions the completion of the task is much more difficult and in
some cases more dangerous.
The following is a list of instructions for weight loss surgery. If you look at this list and feel you would be
unable or unwilling to follow all of the instructions, then it would be best to reconsider your decision. You should
wait to have surgery until you have made the commitment to follow all these guidelines.

· Two to three small meals per day. Patients who fail to lose the expected weight after surgery ,or regain
weight later on, tend to do so because they are eating many small meals or snacking. With snacking it is easy to
get enough calories into your digestive system to fail to achieve your weight loss goals.
· High protein meals. Patients are instructed to eat a diet that consists of about 70% protein and the rest
vegetables. The protein fills the stomach pouch and produces a sensation of satisfaction and fullness that lasts
for hours. In addition, the body needs a certain amount of protein to be healthy and thereby avoid protein
malnutrition.
· No snacking. As mentioned above, this is a frequent cause of weight gain.
· Avoid liquids with calories. Liquids empty quickly from the stomach pouch allowing a lot of calories to
be consumed and producing no long lasting fullness. We encourage our patients to stay well hydrated with
liquids that contain no calories, but to avoid liquids with calories after the early post-op period. This includes
soups, soda drinks, ice cream and shakes, protein shakes, alcohol, etc.
· Stop eating when satisfied. The operation will help you understand this concept. Usually, if one bite to
much is taken, pain and vomiting can result. If a patient persists at overeating, it is possible to stretch the
pouch and eventually sabotage their operation.
· Exercise daily. Exercise impacts the energy output portion of the energy equation. Surgery decreases
energy intake. Exercise burns energy and strengthens muscles that burn energy all day long.
· Be active. A sedentary lifestyle causes obesity. Find ways to be active in addition to exercise.
· Follow-up with physicians. Regular follow-up is also critical for success. This allows your surgeon to
monitor your progress and regularly check for signs of problems. A weight loss clinic has been set up that has
all the components to help you achieve your goals.
· Daily multivitamin and calcium citrate. Because the post op diet lacks certain food groups and because
some operations cause malabsorption of certain nutrients, it is important to supplement the diet with a
multivitamin high in iron and B vitamins. Calcium supplementation is also important.
· Support Group. A great support group experience is available to all patients. Studies have shown that
those patients who regularly attend support group have much better weight loss

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 Resources

· Nutritionist or Registered Dietician

St. George Livewell Center 435-251-3793

Cedar City Hospital 435-359-3687
Garfield Memorial Hospital 435-359-3687
Sanpete Valley Hospital 435-462-4631
Sevier Valley Hospital 435-893-0569

· Psychology/Psychiatry
Amy Brotherson MSW, LCSW 435-669-7109
Tim Kockler Ph. D 435-632-1445
Aubree Sullivan LCSW 435-862-4767
Therapy Associates 435-862-8273
Kristi Shaw MS, LCMHC 435-429-1055
Melyssa Myers LMFT 435-214-1783

*You may choose any licensed psychologist or psychiatrist to perform your pre-
op evaluation.
*You may want to check with your insurance company for preferred providers.

· DRMC Specialty Care Coordinator II - Bariatrics

Jenny Thompson, RN MSN 435-251-1632
jenny.thompson@imail.org

· Bariatric Coordinator @ Utah Surgical Associates

Lorraine Hiner 435-628-1641 or 435-625-0220
Fax: 877-588-3498
lhiner@utahsurgical.com

· Website: utahsurgical.com

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