CMs provide support for bariatric patients

Obesity management means lifetime commitment

Some people who are considering bariatric surgery as a weight-loss option may think they can have a minor operation and start losing weight automatically without having to think of dieting again. That’s where Michelle Coffman, RN, and Sue Lassetter, MA, come in.

"This is a lifetime commitment, just like a transplant patient requires a lifetime commitment. We start educating the patients that bariatric surgery is a tool we give them to facilitate weight loss but they still have to diet and exercise because they have a lifelong chronic disease," says Coffman, owner of Full Spectrum Life in San Jose, CA, and a bariatric case manager.

Coffman helped Good Samaritan Hospital, also in San Jose, establish its bariatric surgery program after starting a program at Stanford University Hospital.

Recognizing that patients who undergo bariatric surgery need long-range support, she and Lassetter started Full Spectrum Life, a support program for bariatric surgery patients.

The company works as independent contractors with bariatric surgery patients at Good Samaritan and other San Jose hospitals.

Lassetter, who is a bariatric patient with a lot of experience as a life coach, facilitates the group meetings while Coffman provides the education.

"We help motive the patients psychologically and help them set goals. I'm the clinical piece and she is the psychological piece," Coffman says.

Statistics from the American Association for Bariatric Surgery show that about 103,000 Americans underwent gastric bypass surgery last year, four times the number who received the procedure just five years ago.

The patients require a lot of support before and after the surgery in order to modify their lifestyles, watching their diet and exercising regularly.

Coffman likens working with patients who undergo bariatric surgery to disease management for obesity.

"Obesity is a chronic disease. You could lump what I do in with a diabetes educator or a cancer support nurse," she says.

Before surgery

Before patients undergo bariatric surgery, Coffman meets with them for about 1½ hours, telling them what to expect during and after the hospital stay and doing the preoperative teaching.

The patient typically has two visits with a dietitian and keeps a food diary for a week so the dietitian can evaluate current eating habits and make recommendations for behavioral changes.

Coffman supports the patients during the preoperative process, reminding them to keep track of the amount of protein they eat, stop drinking sodas, and drink a lot of water. "I do a lot of education and help them make behavioral changes and stay on a proper diet," she says.

Coffman supports the dietitian and helps the patient work to change his or her eating habits prior to surgery.

She takes a patient history and admission as part of the intake process, handles the screening, and assists with the preoperative work-up.

"I operate as an extra pair of eyes for the anesthesiologist during the preoperative screening. We make sure the patient is appropriate for surgery and that he or she doesn’t have a medical problem that would put [him or her] at unnecessary risk," she says.

Screening process

Bariatric surgery patients receive a rigorous screening that includes complete medical work-up, echocardiograms, sleep studies, and a psychiatric evaluation prior to surgery.

The therapist or psychologist sends a written report assuring that the patient is not under undue stress or anxiety and is able to follow instructions.

The psychological evaluation helps determine if the patients have realistic expectations from the surgery.

"We want to make sure they know what they are getting themselves into, what is expected of them, and what the surgery can help them accomplish," Coffman says.

She visits the patients once or twice while they are in the hospital and acts as a liaison between the patient and the surgeon.

When patients are in the hospital, Coffman works with the hospital case manager to facilitate any discharge planning needs.

"Most of the patients are able to go home without a lot of care. Since this is elective surgery, the patients don’t go to skilled nursing facilities or need a lot of post-discharge care. Most are able to return home with follow-up visits to the doctor," she says.

Once the patients are discharged from the hospital, they are encouraged to attend Coffman and Lassetter’s group meetings three times a month.

The group’s meetings often include guest speakers, such as a dietitian who helps patients learn how to order from a restaurant menu and a marriage and family therapist who talks about the emotional issues that can follow bariatric surgery.

Patients have to understand that the surgery isn’t just a quick fix. They have to modify their behavior in order to stay healthy and lose weight.

The patients have to learn that when they are able to eat a limited amount of food, protein should be their first choice. They are encouraged to exercise and take nutritional supplements to prevent nutritional deficiencies. All of this is reinforced in the group meetings.

"We’re trying to make attending the group for a year a requirement. They need support that long — without question. They need a lot of emotional support," she says.