A big part of my internship is class day. Every Monday we have class with all of the UMD College Park interns and have lectures on a variety of topics. These range from clinical practice like working with cancer patients, to technology tools through intern presentations, and to community issues like working with low income populations.
Today was the first of many joint class days! What this means is that not only were all of my fellow interns there, but so were the interns from other local programs. Some programs included Johns Hopkins Bayview Medical Center (our gracious hosts), National Institute of Health (NIH), University of Maryland Medical Center, and Virginia Tech Northern Virginia, just to name a few.
We had a full day. We were greeted with breakfast and socializing with the other interns in the morning, then moved into lectures. There were two main topics today: eating disorders and bariatric surgery. These are both topics that I definitely wanted to learn more about, so I was very excited that we had multiple lecturers on each topic.
First up was Marie DeMarco, MS, RD, LDN, NCC (PS I can’t wait to have letters after my name) . She went over the basics of anorexia nervosa and bulimia nervosa. This included physical, emotional and psychological effects of these disorders on patients. She also reviewed the diagnostic criteria outlined in the DSM IV which houses all of the mental disorders classified by the American Psychiatric Association. An interesting factoid was that in the upcoming edition of DSM IV, binge eating disorder will be moved from the research section into the area with other established disorders. This disorder doesn’t get much attention and this move will legitimize it in practice. Ms. DeMarco shared a lot of stories from her years of private counseling. It was great to hear what kind of language she used with her patients and how to deal with different scenarios. When discussing anorexia, she mentioned a symptom that was new to me: hypercarotenemia. This is when the skin of a patient turns yellow orange. It is caused by consuming foods high in vitamin A too frequently. Part of this eating disorder is rituals surrounding their meals, meaning they may stick to certain favorite foods, which frequently includes carrots. See a light-hearted example of this in The Magic School Bus Goes Cellular.
The second speaker was Maureen Gately, RD, LDN and she discussed what it was like working in a facility designed for patients with an eating disorder. She outlined the different methods of treatments. Some patients come for day visits weekly or biweekly while others spend 2 weeks to a month in the facility. It all depends on the severity of their condition and a wealth of other factors. While there, a multi-disciplinary method is used which includes nutrition consults, personal and group therapy sessions which include family members. She discussed certain challenges as well as strategies that they use in order to slowly improve the patients relationship with food and their personal body image. One method that I found intriguing was that once a week, they will get food from a restaurant for lunch. By doing this continuously, it allows them to integrate these foods back into their diet and feel more comfortable with their food choices. I’m not sure if I will go into this area of practice, but it was really insightful to hear the details of treatment.
After lunch we had three speakers on bariatric surgery including a Registered Dietitian, Suzy Carobrese RD, LDN, CDE, a bariatric surgeon, Kimberly E. Steele MD, PhD candidate, and a recipient of bariatric surgery. All of their lectures complimented each other well while discussing the different types of procedures as well as the risks and requirements for surgery.
I feel that it is a common misconception that getting bariatric surgery is “the easy way out”. Nothing could be further from the truth. These procedures will significantly change how a person is able to live their live. Even before getting to the hospital, each patient must have a documented history of attempted weight loss over a six month period. They then must adopt their post-surgery diet before hand to make sure they can comply. Conservative surgeons like Dr. Steele require that patients lose some weight in order to make the surgery itself easier and less prone to complication.
No matter which surgery option taken, the stomach pouch where food enters is reduced from the size of a football to approximately 1-4oz. From there on, patients must be on several supplements, eat tiny portions and refrain from alcohol-for their entire lives. This is a true lifestyle change that demands commitment. These lectures made that point extremely clear. But they work. Below is a graph showing the maintenance of weight loss in bariatric patients. It is relatively stable, especially when compared to the common yo-yo-ing frequently seen in dieters.
LAGB= Lap Band Adjustable Gastric Banding
BPD= Biliopancreatic Diversion
I would like to state that I am not endorsing any particular method of weight loss but rather just presenting some data that I learned in today’s lecture. Decisions like these need to be made with the appropriate medical professionals. I do think that this is an area that I would like to work in on an outpatient basis. The success is truly remarkable, but only with the proper support system.
Overall, I really enjoyed this joint class day and I look forward to our next one.
Have you every had bariatric surgery? What was your experience?