Las Vegas Bariatrics Medical Guide & Referral Booklet

OPTIMUM GOOD HEALTH IS OUR GOAL

A WORD FROM OUR TOP DOC

Dear Colleague My name is Bernie Hanna, and I have been performing surgeries in Las Vegas since 2000. I would like to introduce my practice Las Vegas Bariatrics, of which I am the founder, president and owner. I founded Las Vegas Bariatrics (LVB) in 2003. LVB is a premier surgical weight-loss facility in Las Vegas.

I am passionate about obesity and weight loss. I’ve been treating obesity and the associated health issues with Bariatric surgery for over 18 years. I’ve performed over 6000 successful Bariatric procedures with excellent results. My team and I utilize the most advanced minimally invasive technologies including Robotics to serve our patients. We are a comprehensive surgical weight loss program and have a fully supportive team including surgeons from different backgrounds, APRNs, dietitians, psychologists, fitness guides, and an involved social network program.

We would love to offer you and your patients, our services. As I always say, “Life is About Choices”. Please allow us to be Your Choice for surgical weight loss solutions. We are always available to provide more detailed information and would be happy to provide a short presentation if required. Please enjoy this introductory packet summary of our services. .

Warm regards Bernie Hanna MD, FACS FASMBS

GET TO KNOW US AT LVB At Las Vegas Bariatrics, we are a proud Bariatric Surgery Center of Excellence accredited by the American Society for Metabolic and Bariatric Surgery. Our highly skilled and compassionate team is dedicated to providing excellence in service for Robotic Bariatric Surgery. Our mission to redefine surgical weight loss compels us to exclusively offer surgical procedures and programs that will be beneficial, safe, and effective for our patients. At Las Vegas Bariatrics, our practice focuses on quality with meticulous attention to detail in order to help our patients achieve true health and wellness. We are dedicated to the long-term success of our patients, going beyond weight loss surgery and into a lifetime of healthy optimal living. Dr. Hanna and his team teach their patients how to lead a healthy lifestyle

by focusing on what’s important. Health maintenance is a journey, so we use a multidisciplinary approach that leads to a healthy and satisfying lifestyle.

Our certified team aims to perfect surgical and non-surgical weight loss by emphasizing nutrition, fitness, and group support. Our team will be by your side before, during, and after surgery. Our team is dedicated to your weight loss journey and will help provide you with the right weight loss plan to meet your specific goals. We commit to being there every step of the way, with safety and quality of care being our focus. We welcome you to embark on your weight loss journey with Las Vegas Bariatrics.

AWARDS AND ACCOLADES

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Center Of Excellence Bariatric Surgery

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Patients’ Choice - 2020 Jan 01, 2020, 2018, 2017, 2014

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Top Surgeon Honors - 2011, 2003, 2002

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BBB Industry Leader - Feb 2018

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Top Doctor - Sep 01, 2020, 2019, 2017, 2015, 2013, 2012, 2007, 2006 On-Time Physician Award - 2020 - Mar 01, 2020

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Chamber Of Commerce Service Excellence Award Las Vegas - 2016

Newsweek Industry Leader - May 2012

Bernie Hanna, MD, FACS FASMBS is an internationally recognized bariatric surgeon and the founder and Medical Director of Las Vegas Bariatrics. He serves as the Medical Director for North Vista Hospital, Sunrise Hospital and Medical Center, and Dignity San Martin Hospital. Dr. Hanna has served as a trauma surgeon, an assistant clinical professor and is a published medical researcher. He has focused and refined his minimally invasive surgical skills by treating obesity and correcting many of the health issues and co-morbidities associated with obesity through bariatric surgery.

Dr. Hanna is an award-winning surgeon, having received “Top Surgeon” honors and “Top Doctor” awards several years in a row. Dr. Hanna’s expertise is performing the Vertical Sleeve Gastrectomy, Gastric Bypass, Gastric Band (Lap-Band) Revision, and weight loss surgery revisions. He routinely performs procedures for Hiatal Hernias and Reflux Surgery. Specializing in advanced laparoscopic surgery, Dr. Hanna stays at the forefront of robotic surgery and bariatrics by being involved in surgical research.

Proud of their Bariatric Surgery Center of Excellence accreditation, Dr. Hanna and his certified team aims to redefine surgical and non-surgical weight loss by emphasizing nutrition, fitness, and group support before as well as after surgery. He teaches his patients on how to lead a healthy lifestyle by focusing on what’s important. Health maintenance is a journey. He uses a multidisciplinary approach that leads to a healthy and satisfying lifestyle.

Morgan M. Pomeranz, MD is board-certified by the American Board of surgery. He is fellowship-trained in advanced minimally invasive Foregut and Bariatric Surgery.

With hundreds of surgeries under his belt he comes to Las Vegas very experienced in all Bariatric procedures.

His training experience includes fellowships at the University of Texas Health Sciences Center at Houston and Bariatric Medical Institute of Texas. Dr. Pomeranz completed his residency at Sunrise Health and an internship at Yale School of Medicine. He is highly skilled in Bariatric surgery, Anti reflux surgery, General surgery, Advanced laparoscopic and robotic surgery.

Dr. Pomeranz is a compassionate and meticulous surgeon who puts his clients first.

He takes joy in being a part of the weight loss journey to wellness with his bariatric patients.

Punam V Patel, MD, FACS joins Las Vegas Bariatrics with fellowship training and private practice experience in advanced minimally invasive foregut and Bariatric surgery. She is trained on the Da Vinci Robotic system and has advanced training in flexible endoscopy for diagnostic and interventional purposes. She is board-certified by the American Board of Surgery.

With hundreds of surgeries under her belt she comes to Las Vegas very experienced in bariatric and foregut procedures. Her training experience includes fellowship at the University of Texas Health Sciences Center at Houston and Bariatric Medical Institute of Texas. She completed medical school and general surgery residency at Rutgers, New Jersey Medical School in Newark, NJ. Her expertise includes bariatric surgery, antireflux surgery, general surgery, advanced laparoscopic, endoscopy, and robotic surgery.

Outside of the OR, Dr. Patel holds CrossFit L1 training certification, is active in CrossFit, hiking, biking, and any activity that gets her outdoors.

Nikesha Mobley, DNP, APRN is a board-certified Acute Care Nurse Practitioner with a Doctor of Nursing Practice degree from the University of Illinois at Chicago. She is a dedicated health care professional with over 15 years of experience. Her background includes surgical nursing, obesity medicine, primary care, and community health. Dr. Mobley is our clinic director overseeing clients as they go through the Bariatric Surgery program, managing their medical weight loss, testing, and approval process. She is compassionate, caring and a real asset to our program.

Nikki is an active member of many professional organizations, including American Association of Nurse Practitioners, American Nurses Association, American Society for Metabolic and Bariatric Surgery, and Secretary of the Las Vegas Chapter of Chi Eta Phi Nursing Sorority. She is also adjunct faculty at the College of Southern Nevada in the school of nursing. In these roles, she provides mentorship and engage in community service activities.

RESOLUTION OF THE HEALTH PROBLEMS IS OUR GOAL In the United States and in many parts of the world, obesity has become a common disease. As with many other medical issues like cancer or heart disease, surgery can be an effective tool in treating obesity. The causes are often complex and sometimes more than just eating too much and exercising too little, but the metabolic effects of obesity can lead to serious health complications.

Bariatric Surgery is not just treating the disease of obesity, but it impacts diseases of the heart, high blood pressure, diabetes, acid reflux, digestive disorders, and the metabolic syndrome to name a few. Bariatric Surgery is a powerful tool in fighting obesity that greatly reduces the risk of death from diseases like cancer, heart disease, and diabetes, it is a pathway to better health.

There is less than a 1% chance of reaching a normal body weight for a lasting period for patients with a BMI greater than 35, and this is what makes Bariatrics Surgery a support option. The surgery affects the hormonal signals that cause the weight gain or the ability to lose the weight. After surgery around 90% of the patients lose 50% of excess body weight and keep it off. Weight loss can not be achieved with Bariatric Surgery alone but with a combination of healthy diet and good exercise routine, the surgery can be life changing.

QUALITY OF LIFE IMPROVED in 95% of the Patients RELATIVE RISK OF MORTALITY REDUCED by 89% in a five year period.

Migraines 57% resolved² Pseudotumor cerebri 84% resolved⁸ Hypercholesterolemia 63% resolved² Hypertension 62% to 70% resolved¹² Metabolic syndrome 80% resolved⁶ Type 2 diabetes 82% to 98% resolved²⁵⁹

Depression 47% reduced² Obstructive sleep apnea 74% to 98% resolved²⁵ Asthma 69% improved² Nonalcoholic fatty liver disease 37% resolution of steatosis⁶ GERD 72% to 95% resolved²³ Polycystic ovarian syndrome 75% resolution of hirsutism¹⁰ 100% resolution of menstrual dysfunction¹⁰

Urinary stress incontinence 44% resolved² Venous stasis disease 95% resolution of venous stasis ulcers⁴ Osteoarthritis/Degenerative joint disease 41% resolved² Gout 72% resolved²

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IMPROVES: Less pain medication use Metabolic syndrome improves, normalizing blood sugars in up to 82% of diabetics allowing them to come off their diabetes medication.

Less time off work Clients who cannot work are now able to reassimilate and be productive in society Fatty liver improves Decrease risk of cancers Insulin Resistance

IMPROVES: • Up to 70% of patients coming off BP medication and better blood pressure control.

• Heart attacks and stroke risk is less.

• Cholesterol • Hyperlipidemia • Lower heart rate • Heart failure • Cardiac function • Reduce cardiac mortality

IMPROVES: • Relieves the stress on joints and often allows people to stop using pain medications and enjoy much more mobility.

• Joint pains: knees, hips and ankles.

• Back pain and spine pain.

• After weight loss surgery the risk of orthopedic surgeries is decreased • Chronic pain syndrome • Joint replacement surgery outcomes

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IMPROVES: Respiratory issues improve Exercise tolerance improves Less asthma events C.O.P.D. Restrictive lung mechanics

IMPROVES: • Fertility during childbearing years.

• PCOS ‘Polycystic Ovarian syndrome’ improves

IMPROVES: • Physical activity with less load and stress on joints.

• Safer pregnancies • Better sex life • Gynecologic surgical outcomes

• Less pain with exercise and better mobility.

• Increased exercise tolerance and energy.

• Flexibility to decrease risk of injury • Cardiorespiratory fitness

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IMPROVES: Self-esteem Depression Social well-being Confidence Companionship Mood Quality of life

IMPROVES: • Patients with kidney and liver failure will qualify for transplants after weight loss surgery.

• Better tolerate dialysis • Improve survival rates with access to kidney transplant

IMPROVES: • Sleep apnea • Overall sleep is better and restful allowing for more productivity during wake time.

• Hypoventilation syndrome • Less use of CPAP

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PROCEDURES

WHAT WE OFFER IS THE BEST The traditional laparoscopic approach is an excellent method to perform the bariatric procedure; however, for those patients with a high BMI (over 55) the procedure becomes more difficult. The abdominal wall becomes much thicker and can make traditional laparoscopic surgery much more challenging. The Da Vinci robot allows for a safe and successful bariatric surgery in high BMI patients.

There is a wide variety of ways to lose weight, starting with making diet and exercise changes. While lifestyle changes may be enough for some it is not realistic for treating obesity and its related comorbidities in others. Bariatric Surgery is a piece of a very intricate puzzle in combating obesity. It is a tool in the weight loss journey. Choosing the right obesity treatment is an important decision that should be made with the guidance of an expert like our surgeons at Las Vegas Bariatrics. Our treatment options offer that piece of the puzzle in the journey for weight loss.

The robotic arm of the Da Vinci robot can rotate 360 degrees, similar to how a surgeon can rotate their wrist, unlike traditional instruments. The robotic arm has capabilities well beyond the traditional laparoscopic instruments, it gives the surgeon the ability to perform surgery in tight spaces and navigate thicker abdominal walls.

The high definition 3-D camera provides more clarity when operating around sensitive tissues, giving more control over small movements and allowing the surgeon to operate with more precision. The cutting-edge technology provided by the robot expands the types of patients that can be treated. Our robotic surgeons are fellowship trained and certified, and every member of the team has been trained in robotic surgery to ensure patient safety.

Robotic Surgery Division

Our Doctors Are Leaders in Da Vinci Robotic Bariatric Surgery

Dr. Pomeranz

Gastric Sleeve / Sleeve Gastrectomy The Gastric Sleeve / Sleeve Gastrectomy procedure is a minimally invasive procedure that takes about 30 minutes to perform. During this procedure a thin vertical stomach is created into a narrow tube like a banana, and the remaining stomach is removed.

The Sleeve Gastrectomy procedure is a restrictive procedure that creates a smaller stomach pouch, limits the amount of food that can be eaten at any one time. Food will still pass through the digestive tract in the usual order allowing for normal digestion. You will feel full sooner and stay full longer. As you eat less food the body will stop storing excess calories and start using its fat supply for energy. In addition, by removing a part of the stomach we eliminate a portion of the hunger hormone Ghrelin which causes a decrease in appetite.

Gastric Bypass Gastric Bypass is a laparoscopic procedure using small incisions to divide the stomach into a small upper pouch and a much larger remnant pouch. The small pouch is then reattached to the small intestine, allowing food to bypass a portion of the digestive track. It is the most involved procedure and the oldest of the three procedures. This surgery leads to a significant reduction in the functional volume of the stomach, which is accompanied by a change to the physiological and physical response to food.

Gastric Band Surgery The gastric band has been phased out and is not offered anymore at LVB.

Gastric Revision Revision bariatric surgery is for patients who have undergone unsatisfactory weight loss surgery. It may be necessary to speed up weight loss or reverse post-surgical weight gain.

We evaluate for band slippage, erosions and device failure. Band to sleeve is the most common revision bariatric surgery performed at LVB.

HIATAL HERNIA, ANTI-REFLUX SURGERY (GERD) The surgery for GERD is called a Nissan Fundoplication. It is a procedure that tightens the junction between the esophagus and the stomach. This is a minimally invasive surgery that takes about an hour to perform. Usually a Hiatal Hernia Repair is performed in conjunction with the fundoplication.

Patients can go home the same day of surgery depending on their overall health.

Linx is a minimally invasive revolutionary treatment for reflux disease. It is a flexible ring made of magnets that is placed around the lower esophageal sphincter (LES). Designed to restore the barrier function of the LES, Linx preserves the physiology function. The strength of the magnets allows food and liquid to pass into the stomach making it possible for patients to belch and vomit, while keeping the LES closed to prevent reflux.

MEDICAL WEIGHT LOSS Under the direction of our Nurse Practitioner and certified dietician Las Vegas Bariatrics offers several medical weight loss options.

Nutrition Creating a balance of healthy eating, attitude and exercise is the key to successful weight loss. Our medical weight loss program combines individualized nutrition with behavior assessment plans to help each patient achieve their weight loss goal with diets that work.

Supplements Weight loss and bariatric surgery changes the way the body processes nutrients. Supplementation is required after surgery to help prevent deficiencies and possible negative side effects from falling short of nutritional needs.

Requirements and length of supplementation are designed on an individual basis, which depends on laboratory values, phase/healing, and compliance.

EXTRA SUPPORT SERVICES

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VITAMIN B-12 Boosting metabolism, increasing energy levels while decreasing fatigue, are some of the many health benefits of Vitamin B-12. It’s an essential vitamin that helps to maintain healthy nerve and blood cells which are vital for good energy levels.

BIOTIN Promoting healthy hair, skin, and nails, Biotin is an important vitamin that stimulates cellular restoration and promotes the growth of new hair follicles. Biotin is a key component to foster healthy hair growth, improve shine, and increase volume of hair, all while improving the overall health of skin and nails.

FAT BURNER Enhancing the burn of fat in the body, detoxifying the liver, boosting metabolism and energy, the Fat Burner is a complimentary aid in the weight loss journey.

Accompanied by lifestyle changes in diet and exercise, Fat Burner’s amino acids and vitamins can maximize the results in weight loss.

GLUTATHIONE Stimulating healthier brighter skin, Glutathione is an antioxidant that aids the body’s ability to process nutrients that are beneficial to the skin. Glutathione rejuvenates the body’s ability to protect itself from degrading and aging by combating free radicals, while promoting a refreshed natural glowing complexion.

BOTOX Relaxing the muscles from contracting, Botox is a purified protein that can reduce the appearance of fine lines and wrinkles. Temporally stopping the muscle movement, Botox can ease the formation of new wrinkles or lines, lift the brows, open eyes, and raise the lips and corners of the mouth creating a softer appearance.

LVB RECOVERY Combat after surgery nausea and fatigue with LVB Recovery. A potent formula that replenishes nutrients and fluids, LVB Recovery is essential in promoting healing and enhancing recovery.

MYERS COCKTAIL Alleviate fatigue and energize the body with Myers Cocktail. An anti-inflammatory cocktail and hearty blend of vitamins that aids in replenishing nutrients, rejuvenating the body and boosting overall health.

LVB BEAUTY Restore your natural glow with a robust blend of antioxidants and glutathione that aids in the health, strength and appearance of the skin.

LVB PURE HYDRATION Achieve relief from dehydration and fatigue with Pure Hydration. A powerful blend of vitamins and electrolytes that restores hydration and replenishes the body’s electrolytes.

Referral Point of Contacts Referrals

Referral Specialist

referrals@lasvegasbariatrics.com

702-384-1160 ex 118

Main Operator

Bariatrics Intake Specialist

info@lasvegasbariatrics.com

702-384-1160 ex 114

Carmen Tellez

Administrator

carmen@lasvegasbariatrics.com

702-384-1160 ex 109

Billie A. Jones

Administrative Assistant

billie@lasvegasbariatrics.com

702-384-1160 ex 104

PRIVATE INSURANCE

SUPPORT SERVICES

Most insurances are accepted. Please contact our office to verify insurance at 702-384-1160. We also offer financing for those without insurance coverage.

Email/Call Unlimited communication to our office for guidance and recommendations during business hours and scheduled times. In case of emergencies, please contact the office regarding post-operative needs, nearest hospital or emergency room. This information will be available and advised to you before your procedure.

Monthly Seminar Required for new patients to learn about surgical and non-surgical guidelines. Lectures given by our providers.

Check with our staff or website for the next updated time and date.

Monthly Support Group / Social Media Clinical speaker(s) at every support group to help guide and facilitate healthy communication with participants.

Participants new or returning are welcome to join in as we discuss topics regarding nutrition, bariatrics and overall health and wellness.

LAS VEGAS BARIATRICS Address:7220 S Cimarron Rd Ste 100, Las Vegas, NV 89113 Email: info@LasVegasBariatrics.com Phone: (702) 384-1160 or (855) LVB – THIN FAX: (702) 489-7610 Website: www.lasvegasbariatrics.com

www.facebook.com/lvbweightloss www.twitter.com/lvbariatrics www.youtube.com/lasvegasbariatrics www.pinterest.com/lvbariatrics www.instagram.com/lasvegasbariatrics

FAQ 1 2 3 4

Q Are your surgeons board certified? surgeons (Bernie Hanna, MD FACS FASMBS, Morgan Pomeranz, MD, and Punam Patel, MD, FACS) are board certified A Our by the American Board of Surgery and have each completed a bariatric fellowship program. They are fellows of the American

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Q What is time frame for recovery? can vary among patients; everyone heals differently with different pain tolerances. After surgery, most patients return A Recovery to work in one or two weeks but may struggle with low energy at first. Our minimally invasive weight loss surgery is done either

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Q How Does Weight Loss Surgery Affect Nutrition? weight loss surgery, the body has difficulty absorbing certain important nutrients, such as: Iron, Vitamin B-12, Folate, A After Calcium, and Vitamin D. The patient will need to take a multivitamin for life. Taking a daily multivitamin, plus other supplements,

College of Surgeons. Our surgeons are trained and certified in the Da Vinci Robotic System. Dr. Hanna is also a Fellow of the American Society for Metabolic and Bariatric Surgery.

Q Will you work with primary care physician or referring specialist to ensure total wellness? a village to ensure a successful patient weight loss program, and it is important that not only LVB is a part of that village A Itbuttakes the patients PCP or specialist. We will work together to ensure that patient care information is shared to continue a smooth transition to follow up care with the patient’s PCP or specialist for 2 weeks, 6 weeks, and 12 month post-surgery visits.

Q What is the typical excess weight loss and improvement of associated health conditions for your patients? results may vary by each individual person, an average majority of bariatric patients will lose about 2/3 of their excess A Although body weight. A patient that is 120 pounds overweight can expect to lose about 80 pounds and keep it off. The surgery can generally cure or improve about three quarters of a patient’s medical problems. There is about a 75% chance that if the patient adheres to the plan put in place by LVB, diabetes, sleep apnea, and high cholesterol can be improved if not cured.

Q Will the patient be on a special diet before surgery? answer is Yes. Several of the insurance companies require that before a patient can qualify for surgery, they are on a weight A The loss program. The patient will be put on a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the

pre-operative diet is to shrink the liver and reduce fat in the abdomen. Dieting helps make it safer during the procedure. When the insurance companies require a physician monitored diet three to six months prior to surgery as part of their coverage requirement, our nutritionist will design a plan about food education, showing a willingness to complete appointments and develop healthier dietary habits.

laparoscopically or robotically. In our procedures, we make several tiny incisions instead of a major cut, resulting in less pain and a shorter recovery time. Patients generally go home the same day or stay in the hospital overnight for observation before returning home.

can prevent or reduce these deficiencies.

“Weight loss surgery is incredibly exciting because it’s the first step in the journey to a healthier, happier you. I specialize in bariatric surgery because it allows me to merge my love of surgery and fitness into a career of helping improve quality of life for my patients. To my future patients, I look forward to training you in your quest to tackle life!”

-Dr. Patel

WHO IS A CANDIDATE FOR BARIATRIC SURGERY? Weight loss surgery is only for the morbidly obese is a common misconception. Most would be surprised that they could be a candidate for weight loss surgery being only 50 pounds overweight. Qualifications for bariatric surgery in most areas include:

Payment Options

1. BMI ≥ 40, or more than 50 pounds overweight.

2. BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

3. Inability to achieve a healthy weight loss sustained for a long period of time with prior weight loss efforts.

It is recommended that bariatric surgery be performed by a board-certified surgeon with specialized experience and training in bariatric and metabolic surgery and is performed at a center that has a multidisciplinary team of experts for follow-up care. This team of experts may include a nutritionist, an exercise physiologist or specialist, and a mental health professional. This is a recommendation by the National Institute of Health (NIH), as well as the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

INSURANCE Most insurances are accepted. Our professional team at Las Vegas Bariatrics will navigate the insurance process with ease. We will contact the insurance company directly to gather information and verify your provider’s coverage.

CASH Las Vegas Bariatrics offers a personal cash investment option for patients without insurance. We understand the challenges of funding a weight loss procedure. That’s why we offer a competitive all-inclusive price and the most comprehensive care available.

FINANCING Las Vegas Bariatrics offers contract financing programs for out-of-pocket bariatric expenses not covered by insurance.

Our financing programs are funded through CareCredit® or Prosper and gives our patients the ability to start their weight loss journey.

QUALIFICATIONS FOR BARIATRIC SURGERY IN MOST AREAS INCLUDE: 1. BMI ≥ 40, or more than 50 pounds overweight.

2. BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

3. Inability to achieve a healthy weight loss sustained for a long period of time with prior weight loss efforts.

Scan the Code To Visit Our Website

phone: 702.384.1160 • fax: 702.489.7610

https://www.lasvegasbariatrics.com

©LVB Dr. Hanna

7220 S. Cimarron Rd., Suite #100, Las Vegas, NV 89113